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GLOMUS TUMOR

Introduction

Glomus tumors are rare, benign papules or nodules that appear predominantly at subungual sites in the distal extremities especially in middle aged women. Glomus tumors are very painful, often causing paroxysmal responses to changes in temperature or pressure. The pain is secondary to glomus body contractions.  Most tumors occur as solitary lesions; however, multiple tumors, even on one fingertip have been reported.  It is important to keep Carroll's triad described in 1972 in mind when attempting to diagnose glomus tumors.4  There are three types of glomus tumors: mucoid hyaline, solid (glomus) and angiomatous.3  Usually glomus tumors are smaller than 1 cm in diameter with most about 5mm in diameter.3,4,5

Incidence and Related Conditions

  • Glomus tumors are rare, accounting for <5% of all soft tissue tumors of the upper extremity
  • While solitary tumors can occur at any age, they are more prevalent in young adults
  • Solitary, subungual tumors are more common in women; multiple lesions are slightly more common among men

Differential Diagnosis

  • Blue nevi
  • Blue rubber bleb nevus syndrome
  • Eccrine spiradenoma
  • Kaposi sarcoma
  • Leiomyoma
  • Maffucci syndrome
  • Neurilemoma
  • Venous malformation
  • Glomangiomyoma
  • Glomangiopericytoma5
  • Solitary variant:
    • There are solitary and multiple glomus variants:
      • Blue or red blanchable papules or nodules in deep dermis or subcutis
      • Acral location, most commonly, especially subungual
    • Multiple variant are also possible1:
      • Regional variant: blue-to-purple partially compressible papules/nodules, grouped and limited to specific area, most often an extremity
      • Disseminated type: multiple lesions distributed over the body, no specific grouping, less common than regional variant
      • Congenital plaque-like: either grouped papules that coalesce to form indurated plaques or clusters of discrete nodules, rarest variant
ICD-10 Codes

  • GLOMUS TUMOR

    Diagnostic Guide Name

    GLOMUS TUMOR

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    GLOMUS TUMOR (HEMANGIOMA OF SKIN/SUBCUTANEOUS TISSUE) BENIGND18.01   

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
Glomus Tumor Clinical Photos
  • Glomus tumor eponychial fold. Note slight lump at arrow.
    Glomus tumor eponychial fold. Note slight lump at arrow.
  • Glomus tumor just radial to midline of the nail . Note mild nail deformity at arrow.
    Glomus tumor just radial to midline of the nail . Note mild nail deformity at arrow.
  • Glomus tumor radial corner of ring fingernail . Note blue/purplish discoloration at arrow and the planned incisions (1&2).
    Glomus tumor radial corner of ring fingernail . Note blue/purplish discoloration at arrow and the planned incisions (1&2).
Symptoms
Pain - severe and pin point
Cold Intolerance
Point Tenderness
Fingernail ridging or blue/purplish nail bed color changes
Typical History

The typical patient is a middle aged female complaining of a exquisite pain that she localizes to one of her fingernails. The patient has often seen multiple physicians, had normal X-rays without a diagnosis or successful treatment. 

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Imaging Studies for Glomus Tumor
  • Imaging Studies for Glomus Tumor
    Imaging Studies for Glomus Tumor
Treatment Options
Treatment Goals
  • Establish an accurate diagnosis
  • Provide successful surgical treatment
Conservative
  • None
Operative
  • Total surgical excision with careful repair of the nailbed.2,3
Treatment Photos and Diagrams
Surgical Excision of Glomus Tumors
  • Left little finger glomus tumor after matrix incision with glomus (arrow) exposed.
    Left little finger glomus tumor after matrix incision with glomus (arrow) exposed.
  • Left little finger glomus tumor excised (arrow)
    Left little finger glomus tumor excised (arrow)
  • Right long finger glomus tumor excision
    Right long finger glomus tumor excision
  • Right long finger glomus tumor about 1cm in diameter after excision.
    Right long finger glomus tumor about 1cm in diameter after excision.
  • Right ring finger glomus tumor with nail off before matrix incision.
    Right ring finger glomus tumor with nail off before matrix incision.
  • Right ring finger glomus tumor after matrix incision with glomus (arrow) exposed.
    Right ring finger glomus tumor after matrix incision with glomus (arrow) exposed.
  • Right ring finger glomus tumor with glomus (arrow) excised
    Right ring finger glomus tumor with glomus (arrow) excised
CPT Codes for Treatment Options

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Common Procedure Name
Excision mass finger (includes glomus tumor and Xanthoma)
CPT Description
Excision of benign tumor; deep, subfascial, intramuscular
CPT Code Number
26116
CPT Code References

The American Medical Association (AMA) and Hand Surgery Resource, LLC have entered into a royalty free agreement which allows Hand Surgery Resource to provide our users with 75 commonly used hand surgery related CPT Codes for educational promises. For procedures associated with this Diagnostic Guide the CPT Codes are provided above. Reference materials for these codes is provided below. If the CPT Codes for the for the procedures associated with this Diagnostic Guide are not listed, then Hand Surgery Resource recommends using the references below to identify the proper CPT Codes.

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CPT 2021 Professional Edition: Spiralbound

Complications
  • Recurrence after insufficient excision
  • Infection
  • Persistent or worsening nail deformity
Outcomes
  • Excision of lesions most often results in cure with low recurrence rates for solitary lesions
  • Malignant glomus tumors are extremely rare; overall prognosis is good if excised with wide margins
Key Educational Points
  • Clinical suspicion and an awareness of Carroll's glomus tumor triad is mandatory for successfully identifying these rare tumors.
  • About one third of glomus tumors are associated with blue/purplish discoloration of the fingernail, nail deformities and bone erosions on plain X-rays. 3,4,5
  • Love's pin test to identify point tenderness and Hildreth's to see if a digital tourniquet eliminates point tenderness can help the diagnostic process for glomus tumors.3
  • MRI can verify the presence of a glomus tumor, however, false negative MRI findings do occur.4
  • MRI can help surgical planning.4
References

Cited and New articles

  1. Sandoval M, Carrasco-Zuber J, Gonzalez S. Extradigital Symplastic Glomus Tumor of the Hand: Report of 2 Cases and Literature Review.Am J Dermatopathol 2014 ePub. PMID: 25051107
  2. Wang PJ, Zhang Y, Zhao JJ. Treatment of subungual glomus tumors using the nail bed margin approach. Dermatol Surg2013;39(11):1689-94. PMID: 24118542
  3. McDermott EM, Weiss AC. Glomus Tumors. J Hand Surg 2006; 31A: 1397-1400. PMID: 17027805
  4. Carroll RE, Berman AT. Glomus tumors of the hand: review of the literature and report on twenty-eight cases. J Bone J Surg Am 1972; 54(4): 691-703. PMID: 4341268
  5. 5. Trehan SK, Athanasian EA, Dicarlo EF, Mintz DN, Dalaiski A. Characteristics of glomus tumor in the hand not diagnosed on magnetic resonance imaging. J Hand Surg Am 2015; 40(3): 542-545.  PMID: 25639840

Reviews

  1. Netscher DT, Aburto J, Koepplinger M. Subungual glomus tumor. J Hand Surg Am2012;37(4):821-3. PMID: 22192165
  2. Cohen PR. Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. Am J Clin Dermatol2011;12(4):217-31. PMID: 21668031

Classic Articles

  1. Murray MR, Stout AP. The glomus tumor: Investigation of its distribution and behavior, and the identity of its "epithelioid" cell. Am J Pathol 1942;18(2):183-203. PMID: 19970623
  2. Rettig AC, Strickland JW. Glomus tumor of the digits. J Hand Surg Am 1977;2(4):261-5. PMID: 197147
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