Epithelial sheath neuroma with extension to the subcutis

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.