A 44-year-old man presented with a lifelong history of an enlarged toe, requiring him to cut out portions of his shoes to obtain a comfortable fit. On physical examination, he had a hypertrophic right fourth toe (Figure 1) and soft tissue proliferation extending approximately 1 cm onto the dorsal aspect of the foot. There was a 5-cm cerebriform mass involving the plantar surface of the fourth and fifth toes (Figure 2). A velvety plaque was localized to the dorsal aspect of the afflicted toe only. An x-ray film showed exostoses involving the fourth metatarsal and phalangeal bones (Figure 3). A deep punch biopsy specimen was obtained (Figure 4).