Case summary A 50-year-old man presented with an ulcerative nodule on the foot. Microscopic examination showed ulcerated skin with an underlying poorly circumscribed, non-encapsulated spindle cell tumour. It consisted of bland fibroblastic cells arranged in sweeping fascicles within a myxofibrocollagenous stroma with vascular channels and occasional mast cells. There was no nuclear atypia and mitosis was inconspicuous. The lesion was positive for CD34 and factor XIIIa. It did not stain for AE1/AE3, EMA, S100 protein, HMB45, smooth muscle actin, desmin and NSE. Based on the clinicopathological and immunohistochemical review, the lesion was in keeping with a superficial acral fibromyx-oma. Discussion Superficial acral fibromyxoma is rare and presents difficulties with the differential diagnoses which could include fibrous histiocytoma, dermatofibrosarcoma protuberans, acquired digital fibrokeratoma, sclerosing perineuroma, cutaneous myxoma and myxoinflammatory fibroblastic sarcoma. The diagnosis is made based on its predilection to develop on the superficial hands and feet, and the described histological and immunohistochemistry studies above. Besides CD34 and factor XIIIa, it also stains for CD99, CD10, vimentin and nestin.