Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis?

Abstract

IntroductionDiagnosis of subungual glomus tumour is mostly based on detailed history and clinical examination. Recently, Magnetic Resonance Imaging (MRI) and Ultrasound have been proposed as the imaging modality to confirm the clinical diagnosis and in planning the surgical management of these tumours. However, these imaging modalities are not routinely available in rural setting and also are expensive. Due to these limitations, we set out to establish that diagnosis and management of these rare tumours can be based solely on a battery of clinical tests and history taking.Materials and MethodsRetrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination.ResultsFemales (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love’s Pin test was positive in all cases (100%). Hildreth’s test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours.ConclusionDiagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.

Clinico-Dermoscopic Aspect and Surgical Procedure of Glomus Tumor

“…Proper pressure of tourniquet is important to create a bloodless field for successful intraoperative dermoscopy [20,11]. Intraoperative dermoscopy also allows, after lesion excision, the visualization of other residual macroscopic tumor foci in the nail apparatus [5]. In this case, we successfully located the tumor and predicted the approximate size of the lesion using nail plate dermoscopy.…”

“…In general, GT are most commonly seen in female patients in the subungual region in the hands, while men often experience these tumors in other body parts [4]. Diagnosis is mainly on clinical grounds although Magnetic resonance imaging (MRI) has been reported to be useful in cases with multiple lesions and in unusual locations [5]. The complete surgical excision is the only effective treatment modality, however, the risk of post-operative nail deformity and recurrences are the major concerns in this regard [6].…”