Epithelial sheath neuroma (ESN) is a rare entity, histologically showing enlarged nerves in the superficial dermis surrounded by cytologically bland keratinocytes, classically presenting clinically as an erythematous papule or nodule on the back of middle-aged to elderly individuals. Clear-cut recommendations for treatment are not available, with many reports citing biopsy alone or simple excision as curative. We report a case of biopsy-proven ESN presenting as a significantly painful nodule in an elderly woman. Surgical excision was performed for symptom control and the residual ESN was found to extend deep into the subcutis.
Inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon variant of keratinocytic epidermal nevus that typically presents as linear erythematous and verrucous papules which often coalesce into plaques. ILVEN is characteristically intensely pruritic and is most commonly found unilaterally on an extremity, the trunk, or buttock in a Blaschkoid pattern. Lesions may be present as early as birth most commonly developing in early childhood before the age of five years old and persisting for months to years. Females are more often affected. We present the case of an adult patient who presented to our clinic for evaluation of her long-standing, treatment-resistant ILVEN. Dermoscopy was used to aid in the diagnosis and exhibited alternating red and brown glomerular-type structures over a white background. We propose that these findings may be added to other previously documented dermoscopic characteristics of ILVEN, as they correspond to known histopathological features of the dermatosis and may aid in non-invasive diagnosis.
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