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]

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Media Gallery

Glomus tumor.
Multiple glomus tumors.
Glomus tumor (4X). The tumor is composed of uniformly round, small, glomus cells with pale eosinophilic cytoplasm associated with conspicuous vasculature.
Glomus tumor (10X).
Glomangioma (2X). In this variant, blood vessels predominate.
Glomangioma (10X). Note the typical small, round glomus cells, often distributed in a monolayer or bilayer within the vessel walls.

of 6

Author

Vernon J Forrester, MD Fellow, Cleveland Clinic

Disclosure: Nothing to disclose.

Coauthor(s)

Jacqueline S Stevens, PhD University of Virginia School of Medicine

Disclosure: Nothing to disclose.

Richard Harold "Hal" Flowers, IV, MD Assistant Professor, Department of Dermatology, University of Virginia Health System

Richard Harold "Hal" Flowers, IV, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Rheumatologic Dermatology Society

Disclosure: Nothing to disclose.

Barbara B Wilson, MD Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Society of Virginia, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Abby S Van Voorhees, MD Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, National Psoriasis Foundation, American Medical Association, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbott for consulting; Partner received salary from Merck for management position; Received honoraria from Abbott for speaking and teaching; Received honoraria from Amgen for review panel membership; Received honoraria from Centocor for consulting; Received honoraria from Leo for consulting; Received none from Merck for other.

Jon H Meyerle, MD Assistant Professor, Department Dermatology, Uniformed Services University of the Health Sciences; Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Walter Reed National Military Medical Center

Jon H Meyerle, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Erin L Spillane, MD Staff Dermatologist, Department of Dermatology, Womack Army Medical Center

Erin L Spillane, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Omar P. Sangueza, MD, and Michael B. Reynolds, MD, to the original writing and development of this article.

Sections Dermatologic Manifestations of Glomus Tumor
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Dermatologic Manifestations of Glomus Tumor Treatment & Management

Surgical Care

References

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