Dermoscopy of glomus tumor:

More white than pink

Elisabeth Rosalie Mutsaers, MD,a Roel Genders, MD,a Nicole van Es, MD,b and Nicole Kukutsch, MD, PhDa
Leiden, The Netherlands

Key words: dermoscopy; glomus tumor; histology; subungual lesions; surgery; therapy.

CLINICAL PRESENTATION
A 15-year-old girl presented with progressive pain of the nail fold of digitus III, especially in cold
weather. Examination of the finger by giving local pressure with a pin point (ie, Love test)1 was
extremely painful on the nail fold (Fig 1).

Fig 1. Clinical image with the arrow as the punctum maximum of pain.

DERMOSCOPIC APPEARANCE
Dermoscopic examination (Fig 2, A) found a homogeneous white area of the nail plate and
disappearance of the lunula. Onychoschizia was present at the distal nail plate.

Fig 2. A, Dermoscopic examination finds a homogeneous white nail plate with distal
onychoschizia. B, Surgical excision of the glomus tumor.

From the Departments of Dermatologya and Pathology,b Leiden
University Medical Center.
Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Elisabeth Rosalie Mutsaers, MD, Dermatologist,
Leiden University Medical Center (LUMC), Albinusdreef 2, 2333
ZA Leiden, The Netherlands. E-mail: rosalie_rosalie@hotmail.
com.
J Am Acad Dermatol 2016;75:e17-8.
0190-9622/$36.00
ª 2016 by the American Academy of Dermatology, Inc.
http://dx.doi.org/10.1016/j.jaad.2016.01.049

e17
e18 Mutsaers et al J AM ACAD DERMATOL
JULY 2016

HISTOLOGIC DIAGNOSIS
Histologic examination found a proliferation of vessels and a pale myxo€ıd stroma surrounded
by monotonous cells with an eosinophilic cytoplasm and round nuclei. No atypical cells were present
(Fig 3). Immunohistochemical findings showed smooth muscle actinepositive lesional cells. These
findings were consistent with the diagnosis of glomus tumor.

Fig 3. Histologic appearance of glomus tumor. (Hematoxylin-eosin stain; original magnification: 3100.)

KEY MESSAGE
The clinical and dermoscopic appearance of glomus tumors can be, as in this case, very subtle.
Nail plate dermoscopy can find the presence of linear vascular structures; however, quite often
these structures can be discrete or absent. Diagnosis can, therefore, be easily missed.2 The key
diagnostic element is the patient’s history of extreme pain on local pressure on the nail fold and
extreme local pain in cold weather. Surgical excision is the only therapeutic option to provide
immediate pain relief (Fig 2, B).

REFERENCES
1. Bhaskaranand K, Navadgi BC. Glomus tumour of the hand. J Hand Surg Br. 2002;27(3):229-231.
2. Maehara Lde S, Ohe EM, Enokihara MY, Michalany NS, Yamada S, Hirata SH. Diagnosis of glomus tumor by nail bed and matrix
dermoscopy. An Bras Dermatol. 2010;85(2):236-238.