Tender Cutaneous Neoplasms: Case Reports of Patients With a Symptomatic Dermatofibroma and a New Acrostic for Painful Tumors of the Skin

Abstract

The most common tender cutaneous neoplasm is a dermatofibroma. The characteristics of three women (35 to 42 years old) with painful dermatofibromas are described. One woman was receiving immunosuppressive therapy for the past decade following a liver transplant; the other women were healthy. The dermatofibroma was located on the buttock, shoulder, and arm, respectively; tumor-related pain had been present for several months to at least a year. The dermal nodules ranged in diameter from 5 millimeters to 12 millimeters and were either flesh-colored to slightly red or brown or tan; one tumor was surrounded by a hyperpigmented patch. Microscopic examination showed the following dermatofibroma variants: classic (fibrocollagenous) in two women and histiocytic in one woman. All the women experienced resolution, without recurrence, of pain following the punch biopsy that only removed the majority (but not all) of the dermatofibroma. Tender cutaneous neoplasms include not only dermatofibromas and other fibrous lesions, but also adipose, bone, calcium, cartilage, eccrine, infiltrative, lymphoproliferative, muscle, neural, and vascular tumors. Acronyms and acrostics are mnemonic devices that have been used by clinicians to aid in recalling the diagnoses associated with painful skin tumors. When there were only 11 or less number of pain-related cutaneous conditions, shorter acronyms associated with either a woman's name, a country or an egg were used. A unique acrostic inspired by Charlotte's Web, a children's book by E. B. White, was created when the differential diagnosis of tender cutaneous neoplasms expanded to 25 tumors. The sequential discovery of additional tender skin lesions resulted in two subsequent minor revisions to the original, hog-related, mnemonic. Herein, a new acrostic --that is not only able to incorporate the inspiration from Charlotte's Web, but also includes cutaneous lymphoma and a final category of "everything else" in order to maintain the future integrity of mnemonic --for the painful tumors of the skin is proposed: HOG FLED PEN AND GETS CALM LIFE BACK (

Glomus Extradigital Tumor: A Case Report of an Extradigital Glomus Tumor on the Wrist and Comprehensive Review of Glomus Tumors

“…There are several painful dermal neoplasms; the glomus tumor is included in the list of these lesions [ 19 ]. In addition to pain, pin-point tenderness and cold sensitivity are the other features that comprise the classic triad of clinical symptoms associated with a glomus tumor.…”

“…Glomus tumor is included in the conditions characterized by tender cutaneous neoplasms [ 19 ]. Pain associated with the lesion not only occurs spontaneously but also can be elicited by pin-point pressure or exposure to cold.…”

“…The patient in this report had localized tenderness for approximately three months. Although a glomus tumor is included in the differential diagnosis for painful tumors of the skin, the possibility of an extradigital glomus tumor was not suspected [ 19 ]. However, as part of the evaluation at her initial visit, an excisional biopsy using a punch biopsy tool, which narrowly removed the entire extradigital glomus tumor, was performed.…”

Tender Subcutaneous Nodule on the Plantar Heel: Answer

“…5 Clinically, the differential diagnosis of ACVL may include other painful skin lesions, including calcinosis cutis, eccrine angiomatous hamartoma, osteoma cutis, piezogenic pedal papule, and plantar fibroma. 6 A diagnosis of ACVL cannot be reliably rendered based on clinical examination alone, and histologic findings are crucial in establishing the diagnosis. Histologically, the diagnosis of ACVL is relatively straightforward because the noncalcified region of ACVL is morphologically consistent with conventional angioleiomyomas, displaying monomorphic spindle cells arranged in a fascicular or whorled pattern.…”