Periungual palisaded encapsulated neuroma in skin of color

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.