Nasal tip schwannoma mimicking rhinophyma.

Geyton T, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-223495 Description Rhinophyma meaning ‘nose growth’ in Greek is a relatively common condition that describes thickening of the nasal skin with enlargement of the sebaceous glands. While not fully understood, it is believed to be a result of vascular instability causing leakage of fluid into the tissues. This subsequently triggers inflammation and scarring. Treatment is initially medical; systemic isotretinoin has been shown to reduce the bulk of rhinophyma. Many surgical techniques have also been described, all of which involve tissue removal. Previous literature has demonstrated other skin conditions mimicking this diagnosis including angiosarcoma, squamous cell carcinoma and sarcoidosis. A 52-year-old woman was referred to ear, nose and throat (ENT) from dermatology for surgical management of rhinophyma. She described a 3-year history of an increasing swelling on the tip of her nose (figure 1). During this time, she underwent extensive conservative treatment with dermatology including a course of isotretinoin to little effect. The appearance of her nose had been causing a significant influence on her mental health and social well-being. She had been prescribed antidepressants by her general practitioner and was reluctant to progress in her career, as this would include more contact with the general public. At first skin incision with a scalpel, instead of the anticipated rhinophyma, a large subdermal mass was unexpectedly encountered (figure 2). This was removed without difficulty, and a good cosmetic result was achieved by reshaping/regrafting the removed skin flap. The mass was sent for histology which surprisingly identified it as a schwannoma. Follow-up at 2 weeks and 3 months confirmed a good cosmetic outcome and patient satisfaction (figure 3). No further management was required. Schwannomas are benign tumours of the nerve sheath that are composed of Schwann cells. They account for between 25% and 45% of head and neck tumours of which 4% are found in the nasal cavity. Schwannomas of the nasal tip are rare with only a handful of cases previously being reported. Preoperative diagnosis can be made based on biopsy or imaging studies where there Nasal tip schwannoma mimicking rhinophyma