Superficial acral fibromyxoma (SAF) is a tumor that occurs on the distal phalanges of the digits. As it does not spontaneously regress and is often associated with pain, the primary treatment is surgical resection. It is often associated with the nail component of the affected digit, and thus cosmesis is an important goal of the operation. We herein describe a case of SAF on the distal phalanges of the fifth digit of the foot beneath the nail, which was successfully resected with the nail component kept intact. Moreover, although SAF is most commonly CD34-positive, the present case was CD34-negative except for endothelial cells within the tumor. While CD34-negative SAF has been previously reported, the current case further indicates that CD34-positivity is not essential for the diagnosis of SAF.