We present a case of a superficial acral fibromyxoma (SAFM) of the distal aspect of the thumb with radiographic evidence of extrinsic pressure erosion of the underlying cortex. This 47-year-old woman presented with a slow-growing mass over the distal aspect of the right thumb that proved to be SAFM on surgical pathology. This is a relatively rare mesenchymal neoplasm of the periungual and subungual regions of fingers and toes.