Pigmented atypical fibroxanthoma is a rare variant of atypical fibroxanthoma and is characterized by extensive areas of hemorrhage, erythrophagocytosis, and hemosiderin accumulation in the cytoplasm of the neoplastic cells. It affects elderly individuals and presents as irregularly pigmented, dome-shaped nodules or plaques on areas of skin exposed to the sun. We present a case of pigmented atypical fibroxanthoma on the cheek of an 81-year-old man. Six years after excision of the lesion, the patient remains in complete remission, with no signs of residual tumor or metastasis. The 9 cases of pigmented atypical fibroxanthoma reported in the literature are reviewed, and the histopathological features and differential diagnosis are discussed.