Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation

Leiomyomas are rare, benign neoplasms that arise from smooth muscles. The condition was first reported in 1854 by Rudolf Virchow [1, 2]. According to the site of origin we can distinguish piloleiomyoma (deriving from the arrector pili muscles of hair follicles), genital leiomyoma (originating from the tunica dartos of the scrotum, and mammary muscles of nipples), and angioleiomyoma (arising from smooth muscles of blood vessels) [3]. The most common locations include the uterus (about 95% of cases) and the skin, which accounts for 75% of extra-uterine leiomyomas [4]. According to Malhotra, the average age of onset is 38.9 years for solitary leiomyomas and 43.8 years for multiple lesions [5].
Herein we report a 41-year-old man with multiple, painful, well-demarcated, oval, red papules localized within the region of the left scapula. The lesions had appeared progressively over the past 6 months. They measured 5 mm to 20 mm and were increasing in size and number (Figure 1). The intensity of the pain was aggravated by pressure and exposure to low temperature. The level of pain was preventing him from sleeping, sitting and participating in normal everyday activities. Family history of similar lesions and physical examination were unremarkable. Based on the clinical picture we assumed multiple leiomyoma. The final diagnosis of leiomyoma was based on histopathological examination of the lesional tissue. It revealed a well-demarcated lobulated tumor located in the reticular dermis. It consisted of bundles of smooth muscle fibers. Tumor cells had eosinophilic cytoplasm and blunt-ended vesicular nuclei. There was no cytologic atypia or mitotic activity (Figure 2). Routine hematological, urine and ultrasound examination of the abdomen did not reveal any abnormalities.
Because of the huge number of leiomyomas, surgical removal was impossible. Treatment with carbon dioxide laser ablation was performed under local anesthesia with 2% lignocaine. We used the following settings: total power output – 10 W, spot size – 1 mm. We performed four procedures with monthly intervals and no side effects had been reported. During a 6-month follow up, the patient was completely asymptomatic and occurrence of new leiomyomas had not been noticed (Figures 1 B, C). Although the cosmetic outcome was not perfect, the resolution of pain seemed to be more important.
Cutaneous leiomyomas are benign tumors of smooth muscle bundles [4]. Piloleiomyomas are the most common type...


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