Dermatologic Manifestations of Glomus Tumor Treatment & Management

Updated: Apr 04, 2019
  • Author: Vernon J Forrester, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Surgical Care

The treatment of choice for symptomatic solitary glomus tumors is total surgical excision, [63] which is curative. While various treatment modalities have been reported, to include laser and sclerotherapy, in the case of solitary glomus tumors, complete removal of the tumor capsule is recommended to relieve pain and minimize risk for recurrence.

Most subungual lesions are treated with total nail avulsion followed by excision, although several additional techniques have been described to include a straightforward excision using a nail bed margin approach, [64] a trap-door technique, [65] and a technique described by Lee et al designed to conserve the nail plate itself. [66] In the transungual approach, the nail plate is removed, the tumor excised, and the nail bed repaired. A lateral subperiosteal approach has also been described, but it may have a higher risk of incomplete excision. Removal of subungual glomus tumors has been reported to have recurrence rates of 2-13% (highest reported at 50%) and nail bed deformity rates of 0-19%. [4, 63, 66, 67, 68, 69] Recurrence can be due to incomplete excision or development of a new lesion, with the probability of recurrence of glomus tumors in general being highest for subungual glomus tumors.

Glomus tumors that are skin-colored or located in the nail matrix have a higher incidence of recurrence. However, the use of preoperative MRI or ultrasound studies in preoperative planning is associated with a lower incidence of recurrence and may be helpful in these cases. [67]

For multiple glomus tumors, excision may be more difficult because of their poor circumscription and the large number of lesions. Other reported treatment modalities, more useful in treating multiple lesions, include argon, carbon dioxide, or Nd:YAG laser therapy, as well as sclerotherapy with hypertonic saline or sodium tetradecyl sulfate. [70, 71, 72, 73]

The treatment recommendations for glomangiosarcoma are based on a few case reports. Wide local excision remains the treatment of choice. Follow-up is important, especially for malignant glomus tumors; one case report highlighted a patient with multiple episodes of local recurrence of malignant glomus tumor treated with excision over a period of 40 years. [74]