Intradermal nodular fasciitis presenting as an eyelid mass

Background. Nodular fasciitis is a fibroblastic proliferation in which nodules, most commonly appearing on the extremities, develop suddenly and rapidly. Although excisional biopsy is curative, the nodules will often resolve spontaneously; however, the histologic appearance of a pleomorphic spindle cell neoplasm with frequent mitotic figures may raise concern of a more malignant neoplasm and lead to unnecessary and overly aggressive therapy. Methods. A case of nodular fasciitis presenting in an unusual location, intradermally at the lateral canthus, is discussed. Results. Review of the recent literature from other disciplines reveals new insights into the etiology and diagnostic options (fine needle aspiration, tomography, other imaging techniques) for this puzzling disease. Conclusions. When nodular fasciitis occurs in an unusual location, such as on the head and neck or at an intradermal location, it will not present as the deep, mobile, nontender nodule described in the dermatologic literature. Fine-needle aspiration and modern imaging techniques may help in the diagnosis and prevent unnecessary surgery for a self-limited condition.