Muscle relaxing agent in cutaneous leiomyoma

Extensive multiple piloleiomyoma in the submental region treated successfully by surgery and reconstruction with a submental perforator flap

Piloleiomyoma is a benign tumour originating in the smooth muscles of the arrector pili muscle in the skin. The lesions are often sensitive to touch, cold and emotional disturbance. We present a patient with multiple piloleiomyoma (MPL) of the submentum who underwent reconstructive surgery using a submental perforator flap. The result was excellent and there were no postoperative complications. MPL of the submental region is relatively rare; to our knowledge, ours is the first report of MPL treated successfully with a submental perforator flap.

Dermal skin template for the management of multiple cutaneous leiomyomas

BACKGROUND

Multiple leiomyomas are rare benign tumors of the skin, originating from the arrector pili muscle, and usually appear as painful nodules. Several pharmacologic agents have been used with some success to reduce pain and discomfort since surgery may be an impractical approach owing to the extent of the disease.

OBJECTIVE

This article reports on a patient with multiple cutaneous leiomyomas of the upper limb who was managed by a method not previously reported for leiomyomas.

METHOD

The management involved total surgical resection of the defect and immediate reconstruction with the Integra artificial dermal template (Integra LifeSciences Corp., Plainsboro, NJ).

RESULTS

With this treatment, the patient was totally relieved from the pain, and optimal functional and esthetic results were achieved.

CONCLUSION

Complete surgical resection of multiple cutaneous leiomyomas prevented the disease's recurrence. The immediate reconstruction of the resultant full-thickness defect with artificial dermis ensured uneventful wound healing, resulting in optimal functional and esthetic outcome and total relief from leiomyoma-associated discomfort.

Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options

Cutaneous smooth muscle is present in 3 separate locations: arrector pili muscles, blood vessel walls, and genital/areolar skin. Benign or malignant smooth muscle neoplasms may arise from each of these locations. This review discusses the pathogenesis, clinical manifestations, histologic findings, prognosis, treatment options, and controversial areas of cutaneous smooth muscle neoplasms. ( J Am Acad Dermatol 2002;46:477-90.)

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be able to discuss the pathogenesis, clinical manifestations, histologic findings, prognosis, and treatment options of cutaneous smooth muscle neoplasms.

Gabapentin treatment of multiple piloleiomyoma-related pain

Familial leiomyomatosis cutis et uteri may present with numerous cutaneous leiomyomas, or piloleiomyomas, which can be painful. Pharmacologic agents have had limited efficacy in mitigating leiomyoma-associated discomfort. We describe a case of familial piloleiomyomas in which intermittent pain at the site of the lesions was substantially reduced by the administration of oral gabapentin. The unusual unilateral distribution of leiomyomas in this case is discussed.

Treatment of multiple cutaneous leiomyomas with CO2 laser ablation

BACKGROUND

Cutaneous leiomyomas are benign tumors that can be exquisitely painful. Symptomatic lesions often necessitate treatment, but many options are inadequate or create substantial morbidity. Without a definitive therapy of first choice, the search continues for alternative methods to alleviate discomfort in affected patients.

OBJECTIVE

To describe the use of CO2 laser ablation for the symptomatic treatment of a 73-year-old woman with multiple cutaneous leiomyomas in whom pharmacologic therapy was contraindicated and surgical excision was impractical.

METHODS

CO2 laser ablation of six symptomatic cutaneous leiomyomas was performed under local anesthesia. After initial success, all remaining symptomatic lesions were treated.

RESULTS

There was complete pain relief in the originally treated lesions 9 months postoperatively, and in all remaining treated lesions 3 months postoperatively.

CONCLUSION

CO2 laser ablation may be an effective alternative treatment for symptomatic cutaneous leiomyomas.

Multiple cutaneous leiomyomas. Report of a case

Multiple cutaneous leiomyomas usually appear as painful nodules of the skin. Historically these have been treated by surgical excision, however, because they are often numerous, surgery may be an impractical approach. This article reports on a patient with multiple leiomyomas of the face treated by excision as well as a discussion of alternative treatments such as pharmacologic agents that may be used when surgical excision is not feasible.

Mast cell density and PGP 9.5-immunostained nerves in angioleiomyoma: their relationship to painful symptoms

Angioleiomyoma is frequently painful and the cause of the pain is unknown. The purpose of this study was to compare the mast cell population and innervation of painful and painless angioleiomyomas. Twenty-four cases of angioleiomyoma were examined; 16 painful and 8 painless cases. Pinacyanol erythrosinate and antibodies to protein gene product (PGP) 9.5 were used to demonstrate mast cells and nerves respectively. PGP 9.5-immunoreactive nerve fibres were found in most of the painful (13/16 cases) and painless lesions (5/8). Mast cells were not seen in half of the painful lesions but were seen in most of the painless lesions (7/8). The median mast cell density was 1.1 cells/mm2 for the painful lesions and 21.9 cells/mm2 for the painless lesions (P = 0.048, Mann-Whitney test). The lower mast cell density in the painful lesions may reflect increased mast cell degranulation. It is proposed that neural and vascular events, similar to those occurring in the triple response to mild cutaneous injury, may produce pain in angioleiomyoma and other painful skin tumours.

Painful tumors of the skin

BACKGROUND

Several cutaneous tumors are characteristically associated with considerable and sometimes incapacitating pain.

OBJECTIVE

A review of the histologic features of these tumors, subjective characteristics of the pain, hypotheses proposed to explain the mechanism of pain production by the tumor, and treatments that have been effective in abolishing or relieving the patient's perception of the stimulus.

METHODS

Review of case reports as well as studies that have proposed mechanisms of pain production based on histologic, electron microscopic, and pharmacologic studies.

RESULTS

Several hypotheses may be equally valid in explaining the cause of pain of a single tumor type, while no apparent cause is found in other types of tumors. There is variability in the success of a treatment between patients.

CONCLUSION

Our understanding of the mechanism of pain production by cutaneous tumors is limited by the small number of studies (and sample size) addressing the issue as well as by our incomplete general understanding of pain production.

Facial leiomyomas

We present a patient with multiple leiomyomas confined to the left cheek, giving rise to an unusual clinical presentation of this condition. The lesions were cosmetically disfiguring and, because of their exposed location, were particularly painful in the winter months. The treatment of this condition is discussed.

Therapy for painful cutaneous leiomyomas

Cutaneous leiomyomas, if multiple and painful, can pose a treatment dilemma. The types of cutaneous leiomyomas and the anatomy and physiology of smooth muscle are reviewed as an introduction to the therapy of painful leiomyomas by a calcium-channel blocker.