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A firm, well-demarcated nodule in the hard palate should make a clinician consider a lesion of peripheral nerve origin, especially palisaded encapsulated neuroma. The age of this patient is indicative of this lesion, but the color and the size are not. The histology is not supportive of palisaded encapsulated neuroma.
Palisaded encapsulated neuroma, also known as solitary circumscribed neuroma, is a benign solitary lesion of peripheral nerve origin, believed to be a reactive rather than neoplastic process. Some suggest that it is reactive to trauma. It was first described on the skin in 1972 and in the oral cavity in 1976. The head and neck area is the most common location for this condition. It occurs most often in the mouth, particularly on the hard palate. It usually presents as an isolated lesion, though it may occur in multiples on rare occasions. It is a small (less than one cm in size), exophytic, smooth surfaced and pink (same color as the surrounding mucosa) nodule. It is usually painless and can be of a long duration. Mucosal sites that are affected include the nose, mouth and glans penis. Palisaded encapsulated neuroma occurs in adults between the fifth and seventh decade with no gender predilection. Conservative surgical removal is the treatment of choice.