Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands which commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurring in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another hospital. The diagnosis was confirmed by additional skin biopsy and immunohistochemistry for receptor tyrosine kinase (cKIT) and epithelial membrane antigen (EMA). Final diagnosis of PCACC was made after excluding the possibility of metastasis from other primary lesion by imaging studies. We proceeded Mohs micrographic surgery and reconstructed the umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus to raise awareness of this rare tumor. Furthermore, we suggest MMS and tacked purse string suture as an effective method to treat PCACC and also for immediate umbilical reconstruction.