Dermal neuroma simulating leprosy.

A 45-year-old Pakistani woman reported to a clinic in Karachi with a one-year history of hypopigmented lesions on the left side of the face and neck. On first presentation the lesions were rough-surfaced and hypoaesthetic; the clinical findings in this highly endemic area of the world suggested macular tuberculoid leprosy. The patient was treated with dapsone for a period of 5 years, but with no change in the appearance or size of the lesions. Subsequent biopsies revealed an unusual neuromatoid pathology in the dermis, in which axons were absent on light and electron microscopy, with neurilemmoma being considered as a possible diagnosis.