Orthopedic Surgery for Glomus Tumor Treatment & Management

  • Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Mar 5, 2012
 

Medical Therapy

Although surgical excision is the only definitive treatment, pain relief should be provided until the procedure is performed.

To destroy the tumor, therapeutic alternatives to surgical excision include sclerotherapy with sodium tetradecyl sulfate or laser treatment with an argon or carbon dioxide laser.[17, 26, 27]

In one study, intralesional injections of hypertonic sodium chloride solution given in 4 sessions over 6 months were found to be effective.[28]

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Surgical Therapy

Surgical excision of the tumor is the mainstay of treatment. Complete excision provides definitive treatment. For multiple glomus tumors, excision may be difficult because the tumors may be poorly circumscribed. Excision should be limited to symptomatic lesions.[17, 29, 30]

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Preoperative Details

Because excision is a minimally invasive procedure, no specific preoperative workup is indicated if the diagnosis is clinically evident. The most crucial and challenging preoperative detail is exact localization of the glomus tumor. MRI may be helpful in this regard.[20]

In lesions on the trunk or an extremity, careful localization and marking are essential for complete and successful excision. The use of methylene blue just before surgery can be helpful.

Because multiple tumors occur in 25% of cases, careful clinical examination and, possibly, radiographic investigation should be conducted to look for additional tumors.

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Intraoperative Details

Lesions in the nail bed are exposed after the nail is removed. A longitudinal incision is made in the sterile matrix, and the matrix is elevated on either side to expose the lesion. The entire flap, including the nail plate, nail bed, and periosteum, should be elevated to excise the circumscribed lesion on the undersurface of the flap or in the bone. Proximal lesions at the level of the germinal matrix should be exposed with a dorsolateral incision made at the junction with the glabrous skin. The flap is then replaced; it can be held with nylon sutures. Complete excision with removal of the entire capsule should be ensured to prevent recurrences.

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Postoperative Details

Pain relief is usually achieved immediately after surgical excision. If symptoms persist after 3 months, exploration should be repeated. Persistence may be due to incomplete excision or multiple lesions, which affect 25% of patients.

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Follow-up

Persistent or recurrent symptoms suggest incomplete excision, and repeat exploration is required. The rate of recurrent symptoms is about 15%.

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Complications

Incomplete excision of the tumor capsule may cause symptoms to persist.

If the tumor extends into the germinal matrix of the nail bed, it may affect nail growth.

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Outcome and Prognosis

The outcome after complete excision with removal of the fibrous capsule is usually excellent, and pain relief occurs immediately after surgery. Recurrences are rare if the capsule is completely excised.

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Contributor Information and Disclosures
Author

Seema N Varma, MD  Attending Physician, Division of Hematology and Oncology, Department of Medicine, Sanford R Nalitt Institute for Cancer and Blood Related Diseases, North Shore Long Island Jewish Health System, Staten Island University Hospital

Seema N Varma, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Nothing to disclose.

Coauthor(s)

Sanam Ahmed, MD  Staff Physician, Department of Internal Medicine, Staten Island University Hospital

Sanam Ahmed, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Terenig Terjanian, MD  Assistant Clinical Professor, Department of Medical Oncology, State University of New York Health Science Center, Brooklyn; Consulting Staff, Director of Hematology/Oncology Division, South Campus, Staten Island University Hospital

Terenig Terjanian, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Albert B Accettola, Jr, MD  Clinical Associate Professor, Department of Orthopedic Surgery, New York University Medical Center; Consulting Staff, Orthopedic Associates of New York, Healthcare Associates in Medicine, PC

Albert B Accettola, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Vincent Ruggiero, MD  Clinical Instructor, Orthopedic Surgery Residency Program, State University of New York Downstate; Consulting Staff, Orthopedic Associates of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Timothy A Damron, MD  David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse

Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine

Disclosure: Lippincott, Williams, and Wilkins Royalty Editing/writing textbook; Genentech Grant/research funds Clinical research; Orthovita Grant/research funds Clinical research; National Institutes of Health Grant/research funds Clinical research

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ian D Dickey, MD, FRCSC  Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Stryker Orthopaedics Consulting fee Consulting; Cadence Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

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Glomus tumor.
Subungual hue seen with a superficial glomus tumor.
Intraosseous glomus tumor appears as a bright, well-delineated mass on a T2-weighted MRI.
 
 
 
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