MRI Evaluation and Surgical Treatment of Gigantic Acquired Digital Fibrokeratoma Arising on the Fifth Toe

Acquired digital fibrokeratoma (ADFK) is a rare benign tumour that can be difficult to diagnose when unusually large or atypical in presentation. We report a man in his 50s with a slowly enlarging lesion on the fifth toe that reached 30 mm over 2 years. MRI revealed a well-circumscribed soft tissue mass with homogeneous, low-signal intensity internally on T1- and T2-weighted images, without features of malignancy. Excisional biopsy confirmed ADFK, and the postoperative defect was reconstructed with a reverse digitolateral flap. After a year, there was no recurrence and both functional and cosmetic outcomes were favourable. This case represents an exceptionally rare presentation of giant ADFK and highlights the importance of preoperative imaging for accurate diagnosis and systematic treatment planning. <b>Level of Evidence:</b> Level V (Therapeutic).