38 year old man has a tender, slightly blue-red, nodule at the base of his thumbnail.
What is your diagnosis?
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 1-2 years and is distorting the nail plate. He reports that when he puts his hand in cold water it is extremely painful.
Glomus tumors are benign neoplasms characterized by vascular spaces surrounded 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 fingers 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) affecting 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 confirmed histologically.
Surgical excision is usually curative.
Reference: Pocket Guide to Cutaneous Medicine and Surgery by Dover, Arndt, LeBoit, Robinson, and Wintroub page 576.
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