MYOMA

Synonyms.—Dermatomyoma; Leiomyoma; Muscle tumor; Fr., Myome cutané;
Ger., Myom; Dermatomyom.

Definition.—Myoma of the skin is a rare tumor, consisting of
smooth muscle-fibers mixed with the fasciculi of fibrous tissue. Besnier²

¹ Bowen, Amer. Jour. Med. Sci., Aug., 1912, p. 189, reports a rare and interesting
case of “Multiple Subcutaneous Hemangiomas, together with Multiple Lipomas,”
consisting of numerous well-defined variously sized tumors; in the smaller and younger
lesions the hemangiomatous element being most pronounced, with a gradual and
progressive increase in the amount of fat tissue as the lesions become more developed,
the latter (fat tissue) in time overshadowing and dominating the vascular growth, so
that the larger tumors were indistinguishable from true lipomas.

² Besnier, “Les tumeurs de la peau, les dermatomyomes," Annales, 1880, p. 25;
ibid., 1885, vol. vi, p. 322; and Besnier-Doyon’s notes to translation of Kaposi’s work,
vol. ii, p. 346 (with reference to reported cases to date). Other important literature:
Crocker, “A Case of Myoma Multiplex of the Skin,” Brit. Jour. Derm., 1897, pp. 1 and
47 (with colored plate and histologic cuts, and a résumé of recorded multiple cases to
date, which includes Hardaway’s case); Neumann, 1897, Archiv, vol. xxxix, p. 3 (with
4 colored plates—2 case illustrations and 2 histologic); Audry, Annales, 1898, p. 182;
Herzog, Jour. Cutan. Dis., 1898, p. 527 (with several histologic cuts and bibliography);
C. J. White, ibid., 1899, p. 266 (with case illustration and histologic cuts; Leslie Rob­
erts, Brit. Jour. Derm., 1900, p. 115 (with a résumé of the preceding 4 cases); Hardaway
(second report on his case), Jour. Cutan. Dis., 1904, p, 375; Nobl, Archiv, 1906, vol.
lxxix, p. 31 (extreme case—disseminated); Beatty, Brit. Jour. Derm., Jan., 1907, p.
1 (multiple; with résumé of 7 multiple cases reported since Roberts’ paper; case and
histologic illustrations with complete bibliography); Heidingsfeld, Jour. Amer. Med.
Assoc, Feb. 16, 1907 (with histologic cuts and review of literature, with references).

MYOMA

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divides the cases into two classes: simple myoma, or leiomyoma, which
is rare and presents as small multiple growths; and dartoic myoma, oc­
curring usually as a large single tumor, and where the cutaneous muscu­
lar development is more abundant, as about the scrotum, mammæ,
female genitalia, and which usually comes under the surgeon’s care.
The latter develops from the cutaneous muscle-fibers, while the former
from the arrectores pilorum muscles or tunica media of the blood-
vessels. In multiple myoma the lesions generally appear as pale rose-
colored, rounded or ovalish, somewhat elevated macules or papules, which
develop into pea-sized tumors. In color they are pink, red, or normal,
elastic to the touch, and with a smooth surface. They are usually
grouped, and are accompanied by a varying amount of pain, sometimes
spontaneous in character, sometimes experienced only on pressure.
They may occur upon any region, but the sides of the face and the arms
have been the most frequent sites. They generally show a tendency to
increase in size and number, and, as a rule, are steadily, though slowly,
progressive; at times spontaneous involution takes place.

The single—dartoic myoma—and more common tumor is generally
met with as a sessile or pedunculated growth, the size of an almond
or walnut or larger. It is situated, as stated, in such regions as the
scrotum, nipple, or labia. As a rule, it is painless, contractile, and pro­
vided with blood-vessels, and grows slowly. When the tumor consists
principally of fibrous tissue, it is known as fibromyoma; when it is highly
vascular, containing many blood-vessels, myoma telangiectodes (also
angiomyoma); and when the lymphatic structures are conspicuously
involved, lymphangiomyoma. This growth, being essentially of surgical
interest, will not be further considered here.

Beyond the fact that females, adults, and middle life seem more
prone to the growths, nothing is known etiologically. In a few instances
they began in childhood. In Brigidi’s case the growths began as an ec-
chymosis. In one of Jadassohn’s it was stated that they followed vac­
cination, doubtless purely a coincidence. Anatomically the multiple
tumors consist of unstriped muscle-fibers, surrounded by elastic tissue,
and take their origin from the arrectores pilorum or from the fibers of the
middle coat of the blood-vessels. There may in some cases also be an
undue development of vascular, lymphatic, and fibrous tissue, giving
rise to the compound names already referred to. Evidences of degen­
eration were noted in White’s case, and the same can probably be seen
in most of those tumors which undergo involution. In the diagnosis of
these tumors the microscope is generally essential. Their insidious
appearance, slow progress, and their usually occurring in circumscribed
localities, with frequently, as they grow larger, considerable pain, and
with no tendency to ulceration, will be sufficient for their recognition
in well-marked cases. The possibility of confusing them with xanthoma,¹
lymphangioma, fibroma, and even with keloid and neurofibroma is to
be kept in mind. As to prognosis the growths are, of course, benign,

¹ See interesting paper by Sutton, “Xanthoma Tuberosum Multiplex Mistaken
for Myomatosis Cutis Disseminata,” Jour. Amer. Med. Assoc, July 20, 1912,
p. 178.

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NEW GROWTHS

and in themselves have no influence on the general health, but if ex­
tremely painful, may indirectly be detrimental.

Treatment consists in their removal by excision. In one instance
(Jadassohn) the pain persisted after extirpation. If the growths are
numerous and excision not advisable or desired, the continued adminis­
tration of arsenic could be tried.

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