SKIN 
 

November 2019     Volume 3 Issue 6 
 

Copyright 2019 The National Society for Cutaneous Medicine 459 

       SHORT COMMUNICATIONS 
 

 

Schwannoma of the Scalp Mimicking a Pilar Cyst 
 
Peter W. Hashim, MD, MHS1, Stephanie Liu, DO, MBA1, Garrett T. Desman, MD1, Cerrene N. 
Giordano, MD1 
 
1Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY  
 

 

Schwannomas are benign nerve sheath 
tumors comprised of myelin-producing 
Schwann cells. Head and neck 
schwannomas constitute roughly 25% of 
cases, but lesions of the scalp are 
uncommon. (1-3)  Here, we describe a 
schwannoma of the scalp that clinically 
presented as a pilar cyst. 
 
 

 

A 17-year-old male presented with a five-
year history of a subcutaneous nodule 
located on his occipital scalp. The patient 
noted slight growth of the lesion over the 
past six months and complained of 
intermittent tenderness. He denied any 
discharge from the area. He was interested 
in surgical removal due to the clinical 
symptoms. His medical history included 
nodulocystic acne. 
 
Physical examination revealed a 2.3 cm x 
2.3 cm firm, mobile, subcutaneous nodule of 
the midline occipital scalp (Figure 1). No 
central punctum was noted. A pilar cyst was 
suspected. The lesion was excised under 
local anesthesia and was removed, without 
difficulty, as a solitary, encapsulated mass.  
 

 

 
Histologic examination revealed a 
circumscribed dermal proliferation of spindle 
cells with nuclei arranged in parallel rows 
and separated by an eosinophilic fibrillar 
material (Figure 2). The neoplasm was 
surrounded by a well-defined capsule 
partially composed of a compressed 
peripheral nerve.  
 
Figure 1. Midline occipital scalp with the outlined 
border of the schwannoma.  

 
 

INTRODUCTION 

CASE  REPORT 



SKIN 
 

November 2019     Volume 3 Issue 6 
 

Copyright 2019 The National Society for Cutaneous Medicine 460 

Figure 2. Histological section (H&E, 20x) showing a 
dermal spindle cell proliferation. 

 
 
 

Schwannomas most often appear between 
the 3rd and 5th decade and show equal 
prevalence between males and females. (2) 
Over 90% arise sporadically as solitary 
lesions, with a natural history of slow growth 
and an absence of symptoms. (4). 
Schwannomas of the head and neck region 
most often occur intracranially, including the 
bilateral “acoustic neuromas” diagnostic of 
type 2 neurofibromatosis. Schwannomas are 
generally considered benign neoplasms, 
although malignant lesions have been 
reported, including on the scalp. (5)  
 
In our case, the patient’s lesion was largely 
asymptomatic, only becoming tender after 
several years of slow growth. Excision was 
straightforward given the well-encapsulated 
nature of the tumor. This case adds to the 
small number of reported schwannomas 
occurring in the superficial tissues of the 
scalp, an uncommon location even amongst 
head and neck schwannomas. (6)  
 
The differential diagnosis of a firm, mobile, 
subcutaneous nodule of the scalp typically 
includes pilar cyst as well as the less 

common dermoid cyst, pilomatricoma, and 
lipoma. Schwannomas are not typically 
suspected, as lesions of the scalp are rarely 
reported. (1, 3) This report highlights that a 
solitary scalp schwannoma can be included 
as an unlikely possibility. Surgery for more 
symptomatic lesions remains the treatment 
of choice.   
 
 
 
 
Conflict of Interest Disclosures: None 
 
Funding: None 
 
Corresponding Author: 
Cerrene N. Giordano, MD  
Department of Dermatology, Icahn School of 
Medicine at Mount Sinai 
325 West 15th Street  
New York, NY 10011 
Tel: (212) 367-0145 
Email: Cerrene.giordano@gmail.com 
 

 

References: 
1. Asuquo ME, Nwagbara VI, Akpan SO, Otobo FO, 

Umeh J, Ebughe G, et al. Recurrent benign 
schwannoma of the scalp: Case report. Int J Surg 
Case Rep. 2013;4(1):65-7. 

2. Langner E, Del Negro A, Akashi HK, Araujo PP, 
Tincani AJ, Martins AS. Schwannomas in the 
head and neck: retrospective analysis of 21 
patients and review of the literature. Sao Paulo 
Med J. 2007;125(4):220-2. 

3. Mohan K, Manjunath H. Cutaneous schwannoma 
masquerading as trichilemmal cyst over scalp in 
a young male. Indian J Dermatol. 
2013;58(5):407. 

4. Beaman FD, Kransdorf MJ, Menke DM. 
Schwannoma: radiologic-pathologic correlation. 
Radiographics. 2004;24(5):1477-81. 

5. Demir Y, Tokyol C. Superficial malignant 
schwannoma of the scalp. Dermatol Surg. 
2003;29(8):879-81. 

6. Leu YS, Chang KC. Extracranial head and neck 
schwannomas: a review of 8 years experience. 
Acta Otolaryngol. 2002;122(4):435-7. 

  

DISCUSSION 

mailto:Cerrene.giordano@gmail.com