A 60-year-old white man seen in consultation for "chronic zoster" presented with a 30-year history of persistent, painful cutaneous lesions on his right flank. His pain was episodic and exacerbated by physical touch and emotional stress. He denied lesion sensitivity to cold or heat. Application ofcapsaicin cream had been without benefit. There was no family history of similar lesions. Physical examination revealed multiple, pink to violaceous, firm, tender nodules (3-7 mm) arising on the right flank in a segmental distribution (Figure 1). No other lesions were noted. A biopsy specimen showed findings of dermal proliferation of spindle-shaped cells with eosinophilic cytoplasm and blunt-ended nuclei without cytologic atypia (Figure 2A and Figure 2B). All of these findings were compatible with a diagnosis of segmental cutaneous piloleiomyomata. He declined surgical or medical intervention.