Abstract: Primary angiosarcoma of the breast is a rare and aggressive malignancy that is typically seen in premenopausal patients. The tumor's spread occurs predominantly through the bloodstream; involvement of the lymphatics is unusual. We present a case of breast angiosarcoma presenting with enlarged axillary lymph nodes treated with a modified mastectomy and axillary lymph node dissection. Pathology found no tumor in the lymph nodes. Based on this experience and data from the literature, we suggest evaluation of the sentinel nodes prior to potentially morbid standard level 1 and 2 axillary lymph node clearance.