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March 1994

A Papule on the Forehead

Author Affiliations

USNR; USNR; Bethesda (Md) Navy Hospital

Arch Dermatol. 1994;130(3):369-370. doi:10.1001/archderm.1994.01690030103017

REPORT OF A CASE  A 42-year-old white man presented with a 3-year history of a gradually enlarging, asymptomatic papule on the right side of his forehead. He was in excellent health and had no history of skin disease. He denied trauma to the area and related that he had used only ''Compound W'' on the lesion. After noting no change in the lesion except increased redness, he was concerned about a possible ''skin cancer.''On the right supraorbital ridge was a 4-mm firm, pink, dome-shaped papulonodule with a small central umbilication and minimal overlying scale (Figure 1). No telangiectasia or protruding hairs were present.A saucerization shave biopsy was performed. The remnant of a gray-white spherule was still evident after the biopsy, but this shelled out easily. Microscopic features are shown in Figure 2 and in Figure 3.What is your diagnosis?

DIAGNOSIS:  Palisaded encapsulated neuroma (PEN).

HISTOPATHOLOGIC FINDINGS  A low-power view showed a fairly well-circumscribed dermal nodule consisting of spindle cells and an

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