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Case of the Month With Crutchfi eld Dermatology
Case A 38-year-old man has a tender, slightly
blue-red, nodule at the base of his thumbnail. It has been increasing in size over the past one to two years and is distorting the nail plate. He reports that when he puts his hand in cold water it is extremely painful.
Diagnosis: Glomus Tumor Glomus tumors are benign neoplasms
characterized by vascular spaces sur- rounded by proliferation of modified smooth muscle cells resembling the arrangement seen in the arteriovenous glomus — a cuff that surrounds the shunt between arterioles and veins on the skin of the digits and elsewhere. Glomus tumors are relatively solid, whereas glomangiomas have fewer glomus cells and are arranged around ectatic vessels.
Glomus tumors are solitary red or
purple nodules found on the skin of the fi ngers or toes, sites rich in normal glomus apparata. Subungual papules can erode underlying bone and also cause nail dystrophy, as in the case presented here. Glomus tumors generally occur in adults and are included in the spectrum of painful cutaneous tumors, along with angioleiomyomas, neurilemomas, eccrine spiradenomas and leiomyoma. Lancinating pain can follow a gentle touch or exposure to cold. Multiple lesions (glomangiomas)
a f fect ing other sites can have a similar appearance but are often less painful. A solitary, painful red or blue acral
papule/nodule is likely to be a glomus tumor. The diagnosis can be confi rmed histologically.
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Treatment Surgical excision is usually curative.
If you have a pat ient wi th a
similar symptom or other skin issues, contact Charles E. Crutchfi eld III, M.D., at Crutchf ield Dermatology or visit www.Crutchfi eldDermatology.com. n
MDNEWS.COM MD NEWS Twin Cities | 17
