Background: Cutaneous acanthamebiasis is a rare infection and few patients have been reported worldwide. Methods: Observational and descriptive study carried out from March 1996 to February 2006 in patients with diagnosis of cutaneous free-living amebic infection caused by . Acanthamoeba spp. The patients were diagnosed at the Dos de Mayo National Hospital (Lima-Peru) where skin biopsies, histopathologic studies and cultures were performed. The clinical and epidemiologic characteristics, diagnosis, treatment and evolution were recorded in a survey. Results: Five patients with cutaneous free-living amebic infection caused by . Acanthamoeba spp. were identified. Skin lesions were ulceronecrotic (four patients), an infiltrative bluish plaque (one patient), and a periorbital tumor (one patient). Three patients were positive for human immunodeficiency virus (HIV), had only cutaneous involvement, and died of opportunistic infections. The two immunocompetent patients developed . Acanthamoeba granulomatous encephalitis and meningoencephalitis that progressed to intracranial hypertension and death. Conclusion: The clinical manifestations of cutaneous free-living amebic infection caused by . Acanthamoeba spp. appear to vary according to the underlying immunologic status. © 2009 The International Society of Dermatology.