A 21-year-old white man presented with a small, reddish brown nodule on the thumb of his right hand. Three months earlier, he had noticed the appearance of an edematous area, 2 mm in diameter, that progressively softened, discharging small amounts of serous secretion. The lesion subsequently became nodular and verrucous. There was moderate pain intermittently, but no pruritus. Some small, pink nodules had also developed on the right forearm. The medical and family history were both unremarkable.