Cutaneous leiomyoma

Cutaneous leiomyoma is a benign tumor of the skin that originates from the smooth muscle cells. These tumors are typically found in the dermis and are often associated with piloerector muscles, which are responsible for causing hair to stand on end. Cutaneous leiomyomas can be solitary or multiple and are generally classified into three types: piloleiomyomas, angioleiomyomas, and genital leiomyomas.

Types

• Piloleiomyomas: These are the most common type of cutaneous leiomyomas and arise from the arrector pili muscle associated with hair follicles. They often present as small, firm, reddish-brown nodules and can be painful, especially in response to cold or tactile stimuli.
• Angioleiomyomas: These tumors originate from the smooth muscle cells of blood vessels. They are typically found in the subcutaneous tissue and can present as solitary, painful nodules.
• Genital leiomyomas: These are rare and occur in the genital region, arising from the smooth muscle of the dartos muscle or the tunica albuginea.

Clinical Presentation

Cutaneous leiomyomas usually present as firm, skin-colored to reddish-brown nodules. They can be solitary or multiple and are often painful. The pain is typically exacerbated by cold, pressure, or emotional stress. Multiple cutaneous leiomyomas may be associated with an inherited condition known as hereditary leiomyomatosis and renal cell cancer (HLRCC), which also increases the risk of developing renal cell carcinoma.

Diagnosis

The diagnosis of cutaneous leiomyoma is primarily clinical, based on the characteristic appearance and symptoms. However, a definitive diagnosis is made through a skin biopsy and histopathological examination. Histologically, cutaneous leiomyomas are composed of interlacing bundles of smooth muscle cells with eosinophilic cytoplasm and elongated nuclei.

Treatment

Treatment options for cutaneous leiomyomas include:

• Surgical excision: This is the treatment of choice for solitary lesions.
• Medications: Pain management can be achieved with analgesics or calcium channel blockers.
• Cryotherapy: This can be used for smaller lesions.
• Laser therapy: Carbon dioxide laser or Nd:YAG laser can be effective in treating multiple lesions.

Prognosis

Cutaneous leiomyomas are benign and do not metastasize. However, they can cause significant discomfort and pain. Regular follow-up is recommended, especially for patients with multiple lesions, to monitor for potential complications such as the development of renal cell carcinoma in cases associated with HLRCC.

Related Pages

• Hereditary leiomyomatosis and renal cell cancer
• Renal cell carcinoma
• Skin biopsy
• Arrector pili muscle
• Subcutaneous tissue
• Dartos muscle
• Tunica albuginea