Solitary neurofibroma of the nasal columella: a rare case with emphasis on cosmetic considerations and management

Introduction and importance: Neurofibromas are peripheral nerve sheath tumors composed of Schwann cells, perineural-like cells, fibroblasts, nerve fibers, collagen strands, and a myxoid matrix. They typically occur in individuals aged 20–30 years and are associated with Neurofibromatosis type 1. Though solitary nodules often arise independently, their presence in the external nasal area is rare and poorly documented. Case presentation: A 34-year-old healthy female presented with a 2-year history of a progressively enlarging mass at the nasal columella, mainly a cosmetic concern without other symptoms or relevant history. Examination revealed a firm, non-tender, freely mobile 10 mm mass at the infratip extending to the columella. Magnetic resonance imaging was suggestive of a neurofibroma. The lesion was excised via an external rhinoplasty approach, and histopathology confirmed the diagnosis. The patient was satisfied with the cosmetic outcome, and no recurrence was observed during 2 years of follow-up. Clinical discussion: Solitary neurofibromas of the external nose are extremely rare, with very few cases documented. Diagnosis requires clinical evaluation, imaging, and histopathological confirmation, including immunohistochemistry to distinguish them from other nerve sheath tumors. Complete surgical excision is the treatment of choice. Conclusion: This case underscores the rarity and educational value of a nasal neurofibroma in this unusual location. It highlights the importance of accurate diagnosis and tailored surgical management, with particular attention to cosmetic outcome. Further reports are needed to refine the understanding and management of such rare tumors.