This is a 28 year old indonesian male who presented with a 20 cm wart like plaque. He says he had it since birth and the lesion has become thicker and more "tree bark like" over the past 28 years. No medical treatment was sought due to lack of specialist services. Verrucous nevus is an epidermal nevi that follow blaschko lines. It is important to screen infants and children for systemic abnormalities. Treatment of epidermal nevi is difficult. Topical therapy (e.g. Retinoids) does not result in resolution. Full thickness surgical excision or CO2 laser can be complicated by hypertrophic scars.