Leiomyoma Cutis

The red, 1- to 3-mm lesions on the right forearm of a 19-year-old man had recently become tender after being asymptomatic for 10 years. The patient described a shooting pain on palpation. Previous biopsy results showed no cancer. He had high blood pressure but was otherwise healthy. His father had similar lesions.

Leiomyomas arise from smooth muscle and are benign. They can be solitary or multiple and pilar, vascular, or genital. Leiomyoma cutis is relatively uncommon; the incidence in men and women is equal. Most patients present with intermittent pain or tenderness with pressure or cold. The lesions are usually smooth, papular, and less than 2 cm in diameter.

The differential diagnosis includes dermatofibromas, glomus tumors, mastocytosis, and neurilemomas. Skin biopsy can confirm the diagnosis. In patients with multiple lesions, consider obtaining a complete blood cell count to rule out erythrocytosis. Because a variant of renal cell carcinoma is associated with familial cutaneous leiomyomas, renal ultrasonography should also be considered. Evaluate women with multiple pilar leiomyomas and leiomyomas of the uterus for familial leiomyomatosis cutis et uteri or Reed syndrome.

Excision of the lesions can be curative. A trial of calcium channel blockers or phenoxybenzamine is warranted for patients with pain who do not want surgery.

References:

REFERENCE:

1.

Albrecht S. Neoplasias and hyperplasias of neural and muscular origin. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds.

Fitzpatrick's Dermatology in General Medicine.

6th ed. New York: McGraw-Hill; 2003:1033-1034.