Multiple Cutaneous Leiomyomas

A 56-year-old woman presented to clinic for the evaluation of tender nodules that had gradually developed on her back and over her shoulders over several years’ time.

History. She had extensive psoriasis of many years' duration that was well managed by guselkumab for the previous 2 years and mild asthma managed by the occasional use of an albuterol sulfate inhaler. The papules and nodules were flesh colored or red-brown, and they gradually increased in size and number (Figures 1 and 2). Some of the papules were tender to touch and to cold temperatures.

Figure 1. Multiple red-brown papules and nodules are clustered on the left shoulder. The surgical marker illustrates a biopsy site.

Figure 2. Multiple tender, red-brown, and flesh colored papules are clustered on the back. The surgical marker identifies a cluster of symptomatic papules that were later treated by conservative excision.

Diagnostic testing. A biopsy revealed dermal fascicles of spindle cells, many of which had vacuolated cytoplasm (Figures 3 and 4).