Subcutaneous myxopapillary ependymal rests are heterotopias of neuroglial tissue that present in the subcutaneous tissue of the sacrococcygeal region. We report a case which presented as a flesh-colored, pedunculated papule near the gluteal cleft. The presence of a congenital lesion near the midline of the spine should alert the clinician to the possibility of spinal dysraphism and necessitates imaging before biopsy. Subcutaneous myxopapillary rests are benign but must be distinguished from their histologic mimic, subcutaneous myxopapillary ependymomas, which are low-grade tumors with metastatic potential.