A right-handed man in his 50s with a history of hepatitis C presented to clinic with a 1-year history of an enlarging painless nodule on his right index finger, which was now causing destruction of his nail. No preceding trauma was reported. On examination, an erythematous 15 × 10-mm well-circumscribed lobulated firm nodule was seen extending from the dorsal surface of the distal interphalangeal joint to the nail plate of the right index finger, causing destruction of the adjacent nail plate (Figure 1A). The lesion did not transilluminate. No other findings were noted on full skin examination. A radiograph of the right hand revealed erosion of the distal phalanx, and 4-mm punch biopsies were taken from the proximal and distal pole of the nodule, highlighting similar histological features (Figure 1B).