Leiomyoma is a benign tumor of smooth muscle origin, most commonly found in the uterus, gastrointestinal tract, skin, and subcutaneous tissue. Less than 1% of all leiomyomas are found in the head and neck. Leiomyoma of the skin is divided into three main subtypes: pilar leiomyoma, angioleiomyoma, and genital leiomyoma. A 27-year-old male presented with four-year history of multiple reddish-brown to skin-colored, raised lesions on right cheek. No history of itching, burning sensation or pain. Personal and medical history was unremarkable. No family history of any neoplasm. Physical examination showed 4-5 skin-colored to erythematous papules and nodules of size ranging from 2x2mm to 4x5mm on right cheek in segmental distribution with smooth surface and no secondary changes. Lesions were firm in consistency and non-tender. A 3mm punch biopsy was taken. Biopsy showed non-epithelial neoplasm involving reticular dermis with features of differentiation towards smooth muscles. The neoplastic cells were arranged in small and long fascicles resembling normal arrector pilorum muscle. The neoplastic cells show abundant pink vacuolated cytoplasm and elongated wavy blunt-ended nuclei. The special stain Masson’s trichrome confirmed the positivity for smooth muscle fibers. Immunohistochemistry study revealed positivity of α-smooth muscle actin (α-SMA). Pilar leiomyoma is the common type of cutaneous leiomyoma. They may be solitary or multiple; when multiple, leiomyomas may develop in a grouped, linear or segmental distribution. Leiomyoma may be innervated and produce paroxysms of pain but those occurring in the head regions are usually not painful. Multiple cutaneous leiomyomas may be associated with uterine leiomyomas, also known as multiple cutaneous and uterine leiomyomatosis (MCUL). It may also be associated with renal cell carcinoma. The treatment is complete surgical excision and recurrence is extremely rare if the excision is complete. In the present case patient underwent surgical excision and no recurrence in 3 months follow-up seen.

Dr Vandana Yadav completed her MD at the age of 29 years from the Institute of Medical Sciences, Banaras Hindu University, India. She is working as an assistant Professor in the Department of Dermatology and Venereology, Hind Institute of Medical Sciences, Lucknow. She has over 5 publications and over 10 presentations.