Painful skin tumor in focus: Cutaneous leiomyomas

Cutaneous leiomyomas (CLs) are rare benign tumors of smooth muscle origin, often presenting as painful papulonodules. Piloleiomyomas, a common subtype, arise from the arrector pili muscles. Although generally benign, they may be associated with hereditary conditions such as Reed syndrome, linked to fumarate hydratase gene mutations, which increase the risk of renal cell cancer. CLs are uncommon and often misdiagnosed, typically presenting in adults and requiring a skin biopsy for confirmation. Treatment options include surgical excision and cryotherapy, though managing multiple lesions can be challenging. A 57-year-old male presented with multiple asymptomatic raised lesions on his back and arms, present for over 30 years. Recently, the lesions had become painful and had increased in size and number. Physical examination revealed multiple firm, tender papulonodular lesions. An excisional biopsy confirmed the diagnosis of leiomyoma cutis. Further evaluation for renal abnormalities was negative. Initial cryotherapy sessions resulted in minimal reduction in lesion size and pain.