A 61-year-old woman with a history of hypertension, hyperlipidemia, diabetes, asthma, and gastroesophageal reflux disease presented with a growth on her third toenail of the right foot for a year. There was no preceding trauma, and attempts to trim the growth were not successful. Examination showed a filiform, bifurcating papule from the medial nail fold of the third toenail of her right foot (Fig 1). Dermatoscopy showed 2 branched, fleshcolored filiform papules, with linear vessels within, crusted tips, and a smaller filiform papule lateral to the branching papule (Fig 2). The lesion was excised, and histopathology revealed a filiform skin lesion with thick orthokeratosis and focal parakeratosis associated with intracorneal hemorrhage (Fig 3, A). Vertically oriented collagen bundles and some dilated vessels were seen in the dermis (Fig 3 , B).