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Unknown: Eyebrow papule in an elderly man

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Unknown: Eyebrow papule in an elderly man
F Landon Clark MD MPH1, Brian Somoano MD1, Janis Taube MD2, Barbara Egbert MD3, Jinah Kim MD PhD2
Dermatology Online Journal 15 (9): 14

1. Department of Dermatology, Stanford University Medical Center
2. Department of Pathology, Stanford University Medical Center
3. Department of Pathology, Veterans Affairs Palo Alto Health Care System

Case synopsis

Figure 1
Figure 1. A skin-colored papule is present on the left eyebrow.

A 70-year-old Caucasian man presented with a several-month history of a solitary, asymptomatic papule on the left eyebrow. His medical history included stage 1A lentigo maligna melanoma and multiple non-melanoma skin cancers. Physical examination demonstrated a solitary 5-mm smooth, dome-shaped skin colored papule with subtle central erosion on the left eyebrow (Fig. 1). No overlying telangiectasias were noted.

Figure 2 Figure 3
Figure 2. Well-defined fasicles and nests of epithelioid tumor cells arranged in a plexiform pattern and set in a dense kelloidal stroma are present (H&E, x400)

Figure 3. High power examination showing the lesional cells are positive for NKI/C3, supporting the diagnosis of cellular neurothekeoma (x100).

A biopsy of the lesion was performed and stained with hematoxylin-eosin (Fig. 2), NKI/C3 (Fig. 3). Histopathologic examination of the skin biopsy specimen revealed a nodular dermal lesion with a surrounding epidermal collarette. The lesion was composed of plump spindle cells arranged in a plexiform pattern in the background of thick, keloidal collagen bundles. The spindle cells have abundant grey cytoplasm and round nuclei with focally prominent nucleoli. Cellular atypia and mitoses were not identified. Immunohistochemical stains show the lesional cells to be positive for NKI/C3 (Fig. 3) and negative for S100 and CD163 (unpublished observations). The lesion was excised.

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