Multiple piloleiomyomas: a case series with dermoscopic features and a literature review

Cutaneous leiomyomas are rare benign tumours originating from smooth muscles, comprising 5% of all leiomyomas [1]. Histopathologically, they are divided into three subtypes: piloleiomyomas developed from the erector pili muscles in the pilosebaceous unit, angioleiomyomas derived from smooth muscle fibres of the cutaneous small- and medium-sized arteries and veins, and genital leiomyomas originated from vulvar, dartoic or mammary muscles [2].
Among these three subtypes, cutaneous piloleiomyomas (CPLs) are the most common. They more often develop in adults, with comparable frequency in men and women, and are frequently accompanied by pain, especially in response to friction or low temperature. CPLs may be solitary or multiple in an individual patient, and usually present as firm pink-to-red or brown papules or nodules. Multiple lesions may show disseminated, clustered or segmental (dermatomal-like) distribution [1, 2].
CPLs are usually clinically misdiagnosed and the proper diagnosis is made upon histopathological examination. Few reports characterizing the dermoscopic findings in CPLs are available in medical literature in English [3–8].
In the paper, we present 3 patients with multiple CPLs to highlight the dermoscopic findings. We also aim to summarize the diagnostic process and treatment methods of multiple CPLs.
Case 1 is a 27-year-old man referred to the Department of Dermatology with a 7-year history of multiple asymptomatic nodules of segmental distribution on the left cheek (Figure 1 A). The patient’s father had similar lesions on the left cheek and trunk. Videodermoscopy showed branching vessels and irregular yellow-white clods (Figure 1 B). Histopathological examination revealed orthokeratotic epidermis with focal intercellular oedema overlaying cords of spindle-shaped cells, which were positive for smooth muscle actin (SMA) and negative for S100 (Figures 1 C, D). On this basis, the diagnosis of segmental CPLs was made.
Case 2 is a 44-year-old man with multiple asymptomatic red nodules of unknown duration (Figure 1 E) and concomitant plaque psoriasis. His family history was irrelevant. Physical examination, apart from psoriatic plaques, revealed presence of over 30 pink-to-red nodules of up to 1.5 cm in diameter, located on the trunk and upper extremities. Videodermoscopy showed discrete pigment network at the periphery of all nodules and vascular structures, predominantly consisting of thick arborizing...


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