Introduction: Ischemic fasciitis (atypical decubital fibroplasia) is a benign reactive lesion that may mimic mesenchymal malignancy. Atypical mitosis has never been reported in such a lesion, which adds an additional challenge to differential diagnosis. Case Report: A 94-yearold chronically immobile and debilitated female presented with a slightly painful and rapidly growing mass over her right back. Based on the clinical and histological features of the lesion, the diagnosis of ischemic fasciitis, a benign reactive lesion of the deep dermis, was made. Active mitosis and atypical mitotic figures were demonstrated in the lesion. Conclusion: Ischemic fasciitis may show atypical mitotic figures that can mislead differential diagnosis.