Case Report: An 85-year-old female presented with a progressively enlarging, fluctuant mass on the frontal scalp following minor head trauma 7-week prior. Initial clinical assessment at a peripheral center were suggestive of a resolving chronic haematoma. Despite conservative management, the lesion developed areas of purple discoloration and enlarging and resulting in constant headaches. Subsequent CT and MRI revealed a metabolically active frontal scalp neoplasm and bilateral cervical lymphadenopathy. Mapping biopsies of the lesion confirmed a high-grade cutaneous angiosarcoma. The patient underwent palliate wide local excision with 3cm margins and reconstruction with split skin graft. Purpose: Primary scalp angiosarcoma is a rare, aggressive endothelial cell malignancy with a poor prognosis. This case highlights the diagnostic pitfalls associated with scalp swellings in the elderly and emphasises the importance of maintaining a high index of suspicion for malignancy when a "haematoma" fails to follow the expected clinical trajectory of resolution. Discussion: Cutaneous angiosarcoma often presents subtly, frequently mimicking benign conditions such as bruising/haematomas - particularly common in the elderly population due to the prevalence of anticoagulation and minor trauma. - Diagnostic Red Flags: Disharmony between the degree of trauma and the size of the lesion, progressive growth beyond the inflammatory phase and multifocal bluish-purple skin staining. - Surgical Challenges: microscopic "skip lesions" are common, necessitating wide surgical margins and complex reconstruction Conclusion: A persistent or atypical scalp "haematoma" in an elderly patient must be treated with caution. Early biopsy is mandatory to exclude angiosarcoma, as delayed diagnosis significantly reduces the window for curative surgical resection and worsens long-term survival.