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Soft tissue neoplasms can be long-standing and do occur on the upper lip. For that reason, they should be considered on the differential diagnosis. Schwannoma should be considered for a firm nodule of the upper lip since this location is a relatively common location for this neoplasm. The age of this patient is not typical and is on the older end of the age range in which this condition occurs. The histology is not supportive of schwannoma.
Schwannoma is a benign, firm, smooth-surfaced, encapsulated and mobile neoplasm of Schwann cell origin. It occurs at any age but is more common in individuals 30-50 years of age with equal sex distribution. The tongue is the most common location, followed by the floor of mouth and the lips. It is also described as occurring within the jaw bones, especially the mandible. Up to 48% of schwannomas occur in the head-and-neck area. They are usually isolated lesions unless they present as part of neurofibromatosis type 1. Shwannoma presents as a slow-growing, firm, rubbery, smooth-surfaced nodule. The histology is usually diagnostic where the lesion is encapsulated and has two patterns: antoni A, the cross section of which gives rise to "verocay bodies," and antoni B, which is loose and resembles neurofibroma. Simple excision is the treatment of choice and recurrence is rare.