OBJECTIVE. This study describes the radiographic, CT, and MR imaging features of surface osteomas of the appendicular skeleton in four patients without Gardner's syndrome or tuberous sclerosis and reviews the incidence and management options of this uncommon tumor. CONCLUSION. On imaging (best seen on CT), the osteomas were homogeneously dense-as dense at the periphery as at the base-and without an accompanying soft-tissue mass, cortical destruction, or intramedullary invasion. The margins of each osteoma were smooth or smoothly lobulated. When the correct diagnosis was considered in two patients, close clinical follow-up or marginal excision were the management options chosen. Histologic examination of the tumors revealed dense sclerotic lamellar bone with haversian systems that showed features similar to those of normal cortical bone. During a follow-up period of 6 months to 5 years, patients have had no local recurrences or metastases.