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 ra
ise concern of a more malignant neoplasm and lead to unnecessary and o
verly aggressive therapy. Methods. A case of nodular fasciitis present
ing in an unusual location, intradermally at the lateral canthus, is d
iscussed. Results. Review of the recent literature from other discipli
nes reveals new insights into the etiology and diagnostic options (fin
e needle aspiration, tomography, other imaging techniques) for this pu
zzling disease. Conclusions. When nodular fasciitis occurs in an unusu
al location, such as on the head and neck or at an intradermal locatio
n, it will not present as the deep, mobile, nontender nodule described
in the dermatologic literature, Fine-needle aspiration and modern ima
ging techniques may help in the diagnosis and prevent unnecessary surg
ery for a self-limited condition.