Heparin-induced skin necrosis is an infrequent condition, complicating unfractionated heparin and more rarely low-molecular-weight heparin administration. Like heparin-induced thrombocytopenia, it is associated with the presence of anti-PF4 antibodies. After reporting 2 observations, we briefly review the clinical features and management of this condition. Early recognition is of the utmost importance since heparin-induced skin necrosis can be associated with HIT, a potentially lethal disorder.