Solitary periungual angiofibromas can often be challenging in the diagnosis and treatment of such common lesions. Because of the various histologic presentations of fibrous skin tumor, a complete differential diagnosis would include hemangioma, seborrheic keratosis, fibroma, and digital fibrokeratoma. Treatment by total sharp excision can often be accomplished, depending on the morphological appearance of the lesion. An incisional biopsy of a more expansile lesion may be warranted.