Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Leiomyoma Treatment & Management

  • Author: Kyle L Horner, MD, MS; Chief Editor: William D James, MD  more...
 
Updated: Apr 21, 2014
 

Medical Care

Because all leiomyomas are tumors, medical management has a limited role in the resolution or destruction of these lesions. However, pharmacologic intervention may alleviate associated pain.

  • Several investigators report that calcium channel blockers, particularly nifedipine, relieves pain associated with many cases of piloleiomyomas.
    • As the name implies, drugs in this class inhibit the movement of extracellular calcium ions across the cell membrane into the smooth muscle cell, thereby inhibiting muscular contraction.
    • These data support the theory that muscle contraction is somehow responsible for pain in at least some tumors.
  • Phenoxybenzamine, an alpha-adrenoceptor blocker, is also reported to be helpful in alleviating pain,[20] including cold-induced pain, in some cases.
  • Gabapentin has also shown promise in alleviating pain from piloleiomyomas; however, larger randomized trials have not yet been conducted.[21, 22]
  • Two case reports describe botulinum toxin therapy for relief of pain associated with leiomyoma, although one suggested a possible placebo effect.[23, 24]

Deterrence

In a study of 1036 randomly selected premenopausal women (age range, 35-49 y), adequate plasma levels of vitamin D (>20 ng/mL) were associated with a reduced risk of uterine leiomyomas. Only 10% of the 620 black women and 50% of the 416 white women in the study had sufficient levels of vitamin D. Compared with women with vitamin D insufficiency, those with sufficient vitamin D had about 32% lower odds of uterine leiomyomas. This relationship was similar for black and white women. There was also an association between daily sun exposure for 1 hour or more and a reduced risk of developing uterine leiomyomas.[25]

Next

Surgical Care

Surgical excision or ablation may be helpful for some symptomatic individuals.

  • Excision is frequently effective with a solitary leiomyoma.
  • Excision of multiple piloleiomyomas is more cosmetically problematic and less effective than excision of solitary leiomyomas. The recurrence of lesions is more common with multiple piloleiomyomas than with single lesions. After excision, subsequent recurrences have been reported to occur from 6 weeks to more than 15 years.[1] One case report described total excision of multiple leiomyomas followed by immediate artificial skin graft, with successful results.[26]
  • One report revealed promising results for pain relief with carbon dioxide laser ablation of several symptomatic leiomyomas over a follow-up of as long as 3-9 months. Only local anesthesia was required for this procedure.
Previous
Next

Consultations

Female patients with multiple leiomyomas should be referred to a gynecologist for evaluation.

  • Women who have multiple cutaneous piloleiomyomas may also have uterine leiomyomas. If the latter are present, the patient most likely has a familial condition called multiple MCUL.[13] This is also known as leiomyomatosis cutis et uteri, or Reed syndrome.
  • A disease variant involving aggressive renal cancer can also occur and is termed HLRCC.[13] Two family kindreds in Finland with uterine leiomyomas had the unusual association of unilateral papillary renal cell carcinoma. Interestingly, 7 members of 1 family had cutaneous nodules. Two of them underwent skin biopsy, which showed multiple cutaneous piloleiomyomas.
  • Reed syndrome is thought to be inherited as an autosomal-dominant trait with incomplete penetrance. As such, not all women in a family are affected, and those who are may have only cutaneous, only uterine, or both cutaneous and uterine leiomyomas.
Previous
 
 
Contributor Information and Disclosures
Author

Kyle L Horner, MD, MS Physician, Grace Dermatology and Micrographic Surgery, Lebanon, OR

Kyle L Horner, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Marion C Miethke, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Dermatology, University of Washington

Marion C Miethke, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

References
  1. Holst VA, Junkins-Hopkins JM, Elenitsas R. Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options. J Am Acad Dermatol. 2002 Apr. 46(4):477-90; quiz, 491-4. [Medline].

  2. Gokdemir G, Sakiz D, Koslu A. Multiple cutaneous leiomyomas of the nipple. J Eur Acad Dermatol Venereol. 2006 Apr. 20(4):468-9. [Medline].

  3. Brooks JK, Nikitakis NG, Goodman NJ, Levy BA. Clinicopathologic characterization of oral angioleiomyomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Aug. 94(2):221-7. [Medline].

  4. Nagata S, Nishimura H, Uchida M, Hayabuchi N, Zenmyou M, Fukahori S. Giant angioleiomyoma in extremity: report of two cases. Magn Reson Med Sci. 2006 Jul. 5(2):113-8. [Medline].

  5. Yagi K, Hamada Y, Yasui N. A leiomyoma arising from the deep palmar arterial arch. J Hand Surg [Br]. Dec 2006. 31(6):680-2. [Medline].

  6. Naguib NN, Nour-Eldin NE, Serag Eldin F, Mazloum YZ, Agameya AF, Abou Seif S, et al. Uterine Artery Embolization for Uterine Leiomyoma: Role of Uterine Artery Doppler in the Pre-Interventional, Interventional and Post-interventional Patient Workup. Ultrasound Obstet Gynecol. 2011 Dec 16. [Medline].

  7. Virchow R. Ueber Makroglossie und pathologische Neubildung quergestreifter Muskelfasern. Virchows Arch (Pathol Anat). 1854. 7:126-38.

  8. Kloepfer HW, Krafchuk J, Derbes V. Hereditary multiple leiomyoma of the skin. Am J Hum Genet. 1958 Mar. 10(1):48-52. [Medline].

  9. Utikal J, Haus G, Poenitz N, Koenen W, Back W, Dippel E. Cutaneous leiomyosarcoma with myxoid alteration arising in a setting of multiple cutaneous smooth muscle neoplasms. J Cutan Pathol. 2006 Sep. 33 Suppl 2:20-3. [Medline].

  10. Spies JB, Bradley LD, Guido R, Maxwell GL, Levine BA, Coyne K. Outcomes from leiomyoma therapies: comparison with normal controls. Obstet Gynecol. 2010 Sep. 116(3):641-52. [Medline].

  11. Ramesh P, Annapureddy SR, Khan F, Sutaria PD. Angioleiomyoma: a clinical, pathological and radiological review. Int J Clin Pract. 2004 Jun. 58(6):587-91. [Medline].

  12. Alam NA, Bevan S, Churchman M, Barclay E, Barker K, Jaeger EE, et al. Localization of a gene (MCUL1) for multiple cutaneous leiomyomata and uterine fibroids to chromosome 1q42.3-q43. Am J Hum Genet. 2001 May. 68(5):1264-9. [Medline].

  13. Alam NA, Olpin S, Rowan A, Kelsell D, Leigh IM, Tomlinson IP, et al. Missense mutations in fumarate hydratase in multiple cutaneous and uterine leiomyomatosis and renal cell cancer. J Mol Diagn. 2005 Oct. 7(4):437-43. [Medline].

  14. Alam NA, Olpin S, Leigh IM. Fumarate hydratase mutations and predisposition to cutaneous leiomyomas, uterine leiomyomas and renal cancer. Br J Dermatol. 2005 Jul. 153(1):11-7. [Medline].

  15. Wei MH, Toure O, Glenn GM, Pithukpakorn M, Neckers L, Stolle C, et al. Novel mutations in FH and expansion of the spectrum of phenotypes expressed in families with hereditary leiomyomatosis and renal cell cancer. J Med Genet. 2006 Jan. 43(1):18-27. [Medline].

  16. Badeloe S, van Geel M, van Steensel MA, Bastida J, Ferrando J, Steijlen PM, et al. Diffuse and segmental variants of cutaneous leiomyomatosis: novel mutations in the fumarate hydratase gene and review of the literature. Exp Dermatol. 2006 Sep. 15(9):735-41. [Medline].

  17. Horton E, Dobin SM, Debiec-Rychter M, Donner LR. A clonal translocation (7;8)(p13;q11.2) in a leiomyoma of the vulva. Cancer Genet Cytogenet. 2006 Oct 1. 170(1):58-60. [Medline].

  18. Woertler K. Soft tissue masses in the foot and ankle: characteristics on MR Imaging. Semin Musculoskelet Radiol. 2005 Sep. 9(3):227-42. [Medline].

  19. Nakayama H, Enzan H, Miyazaki E, Kuroda N, Toi M. Lack of CD34 positive stromal cells within angiomyomas (vascular leiomyomas). J Clin Pathol. 2002 May. 55(5):395-6. [Medline].

  20. Batchelor RJ, Lyon CC, Highet AS. Successful treatment of pain in two patients with cutaneous leiomyomata with the oral alpha-1 adrenoceptor antagonist, doxazosin. Br J Dermatol. 2004 Apr. 150(4):775-6. [Medline].

  21. Alam M, Rabinowitz AD, Engler DE. Gabapentin treatment of multiple piloleiomyoma-related pain. J Am Acad Dermatol. 2002 Feb. 46(2 Suppl Case Reports):S27-9. [Medline].

  22. Scheinfeld N. The role of gabapentin in treating diseases with cutaneous manifestations and pain. Int J Dermatol. 2003 Jun. 42(6):491-5. [Medline].

  23. Sifaki MK, Krueger-Krasagakis S, Koutsopoulos A, Evangelou GI, Tosca AD. Botulinum toxin type A--treatment of a patient with multiple cutaneous piloleiomyomas. Dermatology. 2009. 218(1):44-7. [Medline].

  24. Onder M, Adisen E. A new indication of botulinum toxin: leiomyoma-related pain. J Am Acad Dermatol. 2009 Feb. 60(2):325-8. [Medline].

  25. Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013 May. 24(3):447-53. [Medline].

  26. Gravvanis A, Kakagia D, Papadopoulos S, Tsoutsos D. Dermal skin template for the management of multiple cutaneous leiomyomas. J Cutan Med Surg. 2009 Mar-Apr. 13(2):102-5. [Medline].

  27. Abraham Z, Cohen A, Haim S. Muscle relaxing agent in cutaneous leiomyoma. Dermatologica. 1983. 166(5):255-6. [Medline].

  28. Archer CB, Greaves MW. Assessment of treatment for painful cutaneous leiomyomas [letter]. J Am Acad Dermatol. 1987 Jul. 17(1):141-2. [Medline].

  29. Archer CB, Whittaker S, Greaves MW. Pharmacological modulation of cold-induced pain in cutaneous leiomyomata. Br J Dermatol. 1988 Feb. 118(2):255-60. [Medline].

  30. Chuang GS, Martinez-Mir A, Geyer A, Engler DE, Glaser B, Cserhalmi-Friedman PB, et al. Germline fumarate hydratase mutations and evidence for a founder mutation underlying multiple cutaneous and uterine leiomyomata. J Am Acad Dermatol. 2005 Mar. 52(3 Pt 1):410-6. [Medline].

  31. Fernandez-Pugnaire MA, Delgado-Florencio V. Familial multiple cutaneous leiomyomas. Dermatology. 1995. 191(4):295-8. [Medline].

  32. Fitzpatrick JE, Mellette JR Jr, Hwang RJ, Golitz LE, Zaim MT, Clemons D. Cutaneous angiolipoleiomyoma. J Am Acad Dermatol. 1990 Dec. 23(6 Pt 1):1093-8. [Medline].

  33. García Muret MP, Pujol RM, Alomar A, Calaf J, de Moragas JM. Familial leiomyomatosis cutis et uteri (Reed's syndrome). Arch Dermatol Res. 1988. 280 Suppl:S29-32. [Medline].

  34. Geddy PM, Gray S, Reid WA. Mast cell density and PGP 9.5-immunostained nerves in angioleiomyoma: their relationship to painful symptoms. Histopathology. 1993 Apr. 22(4):.5-immunostained nerves in angioleiomyoma: their relationship to painful sympto. [Medline].

  35. Laporte M, Achten G, Gheeraert P, Lowy M, Vokaer A. [Multiple leiomyoma treated with nifedipine: association with an astrocytoma]. Dermatologica. 1985. 171(6):486-90. [Medline].

  36. Newman PL, Fletcher CD. Smooth muscle tumours of the external genitalia: clinicopathological analysis of a series [published erratum appears in Histopathology 1991 Aug;19(2):198]. Histopathology. 1991 Jun. 18(6):523-9. [Medline].

  37. Raj S, Calonje E, Kraus M, Kavanagh G, Newman PL, Fletcher CD. Cutaneous pilar leiomyoma: clinicopathologic analysis of 53 lesions in 45 patients. Am J Dermatopathol. 1997 Feb. 19(1):2-9. [Medline].

  38. Spencer JM, Amonette RA. Tumors with smooth muscle differentiation. Dermatol Surg. 1996 Sep. 22(9):761-8. [Medline].

  39. Thompson JA Jr. Therapy for painful cutaneous leiomyomas. J Am Acad Dermatol. 1985 Nov. 13(5 Pt 2):865-7. [Medline].

  40. Vellanki LS, Camisa C, Steck WD. Familial leiomyomata. Cutis. 1996 Jul. 58(1):80-2. [Medline].

  41. Venencie PY, Bigel P, de la Charrière O, Lemonnier V, Thébaut-Gerbaud D, Saurat JH. [Multiple cutaneous leiomyomatosis. Treatment with phenoxybenzamine]. Ann Dermatol Venereol. 1982. 109(9):819-20. [Medline].

  42. Venencie PY, Puissant A, Boffa GA, Sohier J, Duperrat B. Multiple cutaneous leiomyomata and erythrocytosis with demonstration of erythropoietic activity in the cutaneous leiomyomata. Br J Dermatol. 1982 Oct. 107(4):483-6. [Medline].

Previous
Next
 
These multiple hyperpigmented nodules are piloleiomyomas on an upper extremity.
Upon closer inspection, one can appreciate that these piloleiomyomas are superficial dermal nodules.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.