DermDx: Asymptomatic Growth on Cheek

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A 41-year-old woman requests the removal of a growth on her right cheek. The lesion has been present for approximately 1 year and is asymptomatic. Her medical history is unremarkable and she is not taking any medications. She denies a family history of genodermatoses. Upon examination, a 0.7cm firm, flesh-colored nodule is observed. Scattered nevi are noted elsewhere.

Palisaded encapsulated neuroma (PEN) is a rare neural tumor that was first described in 1972.1 The most common presentation is that of a solidary, flesh-colored, smooth-surfaced nodule with a dome shape usually under 0.6 cm in diameter.2 The neoplasm is...

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Palisaded encapsulated neuroma (PEN) is a rare neural tumor that was first described in 1972.1 The most common presentation is that of a solidary, flesh-colored, smooth-surfaced nodule with a dome shape usually under 0.6 cm in diameter.2 The neoplasm is equally common among men and women and most frequently arises on the face; although locations elsewhere have been reported including the tongue,3 buccal mucosa,4 and glans penis.5

Several case reports document the occurrence of multiple lesions necessitating differentiation from neurofibromatosis or multiple endocrine neoplasia syndrome.2,6 Malignant transformation has not been reported.

Diagnosis is by histology, which reveals a circumscribed lesion composed of bundles of bland-looking spindle cells of neural origin situated within the dermis.7 Histology is similar to both a neurofibroma and schwannoma. Excision is curative.2

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.  

References

  1. Reed RJ, Fine RM, Meltzer HD. Palisaded, encapsulated neuromas of the skinArch Dermatol. 1972;106(6):865-870.
  2. Batra J, Ramesh V, Molpariya A, Maan KK. Palisaded encapsulated neuroma: an unusual presentationIndian Dermatol Online J. 2018;9(4):262-264.
  3. Mortazavi N, Gholami A, Amini Shakib P, Hosseinkazemi H. Palisaded encapsulated neuroma of the tongue clinically mimicking a pyogenic granuloma: a case report and review of literatureJ Dent (Tehran). 2015;12(7):537-541.
  4. Atarbashi-Moghadam S, Lotfi A, Salehi Zalani S, Mokhtari S. Palisaded encapsulated (solitary circumscribed) neuroma of the buccal mucosa: a rare caseJ Dent (Shiraz). 2017;18(4):314-317.
  5. Val-Bernal JF, Alvarez-Cañas C, Vega A. Palisaded encapsulated neuroma of the glans penisUrology. 1995;45(4):689-691.
  6. Halder C, Sen S, Gangopadhyay A, Bala S. Zosteriform palisaded encapsulated neuroma: an unusual presentationIndian J Dermatol. 2013;58(6):492.
  7. Leblebici C, Savli TC, Yeni B, Cin M, Aksu AEK. Palisaded encapsulated (solitary circumscribed) neuroma: a review of 30 casesInt J Surg Pathol. 2019;27(5):506-514.
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