Periungual palisaded encapsulated neuroma in skin of color

Authors

  • Christina Pierce Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA Author
  • Federico Galar Division of Dermatology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA Author
  • Joshua Owen Division of Dermatology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA , Dermatology Service, Audie L. Murphy Memorial Veterans’ Hospital, South Texas Veteran Health Care System, San Antonio, TX, USA Author

DOI:

https://doi.org/10.25251/71cbfr95

Keywords:

nail unit, nerve sheath tumor, neuroma, palisaded encapsulated neuroma

Abstract

Palisaded encapsulated neuroma (PEN) is a nerve sheath tumor most commonly found on the face. These benign tumors are less commonly reported in skin of color and may be confused with other forms of nerve sheath tumors. Detection of the distinctive histopathologic features of PEN and recognition of its various subtypes are key to an accurate diagnosis. We report a 68-year-old Black man with a pink to skin-colored papule on the right second fingertip of 6- to 12-month duration. We describe the clinical and pathologic diagnosis of PEN and discuss the differential diagnosis. This case highlights the importance of maintaining a broad differential when managing and treating neoplasms of the nail unit, including rare or uncommon diagnoses.

References

1. Hall LD, Ferringer T. Palisaded encapsulated neuroma. Cutis. 2013 Oct;92:167, 177-8. [PMID: 24195095]

2. Reed RJ, Fine RM, Meltzer HD. Palisaded, encapsulated neuromas of the skin. Arch Dermatol. 1972 Dec;106:865-70. [PMID: 4639250]

3. Dubovy SR, Clark BJ. Palisaded encapsulated neuroma (solitary circumscribed neuroma of skin) of the eyelid: report of two cases and review of the literature. Br J Ophthalmol. 2001 Aug;85:949-51. [PMID: 11466253].

4. Koutlas IG, Scheithauer BW. Palisaded encapsulated ("solitary circumscribed") neuroma of the oral cavity: a review of 55 cases. Head Neck Pathol. 2010 Mar;4:15-26. [PMID: 20237984].

5. Mehta N, Sathyan A, Agarwal S, Bhari N. Multiple palisaded encapsulated neuromas presenting as cobblestoned plaques over palms and oral cavity. J Cutan Pathol. 2024 May;51:332-337. [PMID: 38246881].

6. Rashid RM, Rashid RM, Thomas V. Subungal traumatic neuroma. J Am Acad Dermatol. 2010 Jul;63:e7-8. [PMID: 20542172].

7. Whitehouse HJ, Urwin R, Stables G. Traumatic subungual neuroma. Clin Exp Dermatol. 2018 Jan;43:65-66. [PMID: 29055068].

8. Choi R, Kim SR, Glusac EJ, Zubek A. Subungual neuroma masquerading as green nail syndrome. JAAD Case Rep. 2021 Dec 15;20:17-19. [PMID: 35024402].

9. Bhatt KD, Fernandes R, Dhurat R. Ultrasound biomicroscopy of the skin to detect a subclinical neuroma of the proximal nail-fold. Indian J Dermatol Venereol Leprol. 2006 Jan-Feb;72:60-2. [PMID: 16481717].

10. Conway J, Magro CM, Lipner SR. Expanding the Differential Diagnosis of the Painful Nail: A Case of an Onychopapilloma with Neuroma. Case Rep Dermatol. 2024 Mar 28;16:88-93. [PMID: 38550795].

11. Leblebici C, Savli TC, Yeni B, Cin M, Aksu AEK. Palisaded Encapsulated (Solitary Circumscribed) Neuroma: A Review of 30 Cases. Int J Surg Pathol. 2019 Aug;27:506-514. [PMID: 30834800].

12. May C, LeBoit P, McCalmont T, Argenyi Z. Hypercellular Encapsulated Neuroma Imitating Desmoplastic Melanoma. Am J Dermatopathol. 2019 May;41:358-360. [PMID: 30531539].

13. Jokinen CH, Ragsdale BD, Argenyi ZB. Expanding the clinicopathologic spectrum of palisaded encapsulated neuroma. J Cutan Pathol. 2010 Jan;37:43-8. [PMID: 19614730].

14. Newman MD, Milgraum S. Palisaded encapsulated neuroma (PEN): an often misdiagnosed neural tumor. Dermatol Online J. 2008 Jul 15;14:12. [PMID: 18718196].

15. Koutlas IG, Scheithauer BW. Palisaded encapsulated ("solitary circumscribed") neuroma of the oral cavity: a review of 55 cases. Head Neck Pathol. 2010 Mar;4:15-26. [PMID: 20237984].

16. Argenyi ZB, Santa Cruz D, Bromley C. Comparative light-microscopic and immunohistochemical study of traumatic and palisaded encapsulated neuromas of the skin. Am J Dermatopathol. 1992 Dec;14:504-10. [PMID: 1281969].

17. Zelger BG, Steiner H, Kutzner H, Rütten A, Zelger B. Verocay body--prominent cutaneous schwannoma. Am J Dermatopathol. 1997 Jun;19:242-9. [PMID: 9185909].

18. Dover JS, From L, Lewis A. Palisaded encapsulated neuromas. A clinicopathologic study. Arch Dermatol. 1989 Mar;125:386-9. [PMID: 2923447].

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Published

01/05/2026

Issue

Vol. 31 No. 6 (2025): Dermatology Online Journal

Section

Case Report

License

Copyright (c) 2026 Christina Pierce, Federico Galar, Joshua Owen (Author)

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This work is licensed under a Creative Commons Attribution 4.0 International License.