Ava Monroe
Glomus tumours, also known as paragangliomas, are growths that are usually found on the nail bed or palm of a young adult. They are benign and often appear as small, dark red or blue lesions that can cause sensitivity to cold, tenderness and pain. Surgical intervention is the only treatment option, but because the tumours are benign, recurrence is uncommon. The surgery is performed under regional block anesthesia and is an outpatient procedure. The nail bed is sometimes removed, depending on the tumour's location, and an incision is made to expose and remove the tumour. The site is then closed, and the nail is replaced. The nail is expected to regrow within 3-4 months, and patients experience relief from pain and cold intolerance symptoms post-surgery.
| Characteristics | Values |
|---|---|
| Location | Nail bed, palm, wrist, forearm, finger pads, fingertips |
| Appearance | Small dark red or blue lesions |
| Symptoms | Pain, cold sensitivity, tenderness, burning pain |
| Diagnosis | Biopsy, MRI, ultrasound |
| Treatment | Surgical excision, nail-preserving approach, nail-sparing and sub-nail bed approach |
| Anesthesia | Regional block, digital nerve block |
| Recovery | 3-4 months for nail regrowth, pain relief is immediate |
| Recurrence | Uncommon, but possible nearby |
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What You'll Learn
Glomus tumour symptoms
Glomus tumours, or paragangliomas, are usually benign, slow-growing tumours that can occur in the head, neck, and adrenal gland. They can also occur in the gastrointestinal tract, mediastinum, trachea, mesentery, cervix, and vagina, although this is rare. Glomus tumours are often found in the middle ear, but they can also develop in the carotid arteries in the neck, the jugular bulb, and the deep neck area along the course of the vagus nerve.
The symptoms of a glomus tumour depend on its location. When found in the head and neck region, glomus tumours can cause hearing loss, pulsatile tinnitus, and a pulsing or swishing sound in the ear. If the tumour grows large enough, it can cause difficulty swallowing, speaking, or breathing. Glomus tumours can also affect the movement of the shoulders and tongue, and cause facial nerve weakness or spasms.
Glomus tumours that occur in the neck and carotid arteries may secrete catecholamines, which affect the body's stress hormone, norepinephrine. This can cause high blood pressure and an increased heart rate.
Glomus tumours that occur on the nail bed or palm of a young adult are typically painful, particularly when exposed to changes in temperature or pressure. They appear as a reddish-blue papule or nodule, usually about 1-2 cm in size.
If a glomus tumour is suspected, a physical exam is performed, and imaging tests such as an MRI, CT scan, or angiogram may be ordered to confirm the diagnosis and determine the best treatment approach. Treatment options include surgery, radiation, and stereotactic radiosurgery, depending on the size and location of the tumour.
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Surgical removal of the tumour
Glomus tumours, also known as paragangliomas, are benign growths that are most often found in the nail bed under the fingernails. They can also be found in finger pads, as well as on the palm, wrist, and forearm. Surgical excision is the most common treatment for glomus tumours, and the procedure is typically curative.
The surgical approach to removing a glomus tumour depends on its location. The two most common techniques are the lateral subperiosteal approach and the subungual approach. For peripheral or laterally located lesions, the lateral subperiosteal approach is used. This involves removing the nail and making an incision along the lateral border of the nail bed to expose the tumour. After the tumour is removed, the cavity is curetted, washed, and the wound is closed in layers. The overlying nail can then be retained or discarded. Preserving the overlying nail results in less postoperative pain and protects the nail bed from exposure and trauma.
The subungual approach is commonly chosen for tumours located in the subungual area. This approach allows for complete exposure of the underlying bone and easy access to the tumour, which can be located anywhere under the nail bed. The nail plate may be partially or completely removed, and the tumour is excised by cutting through the nail bed. The nail bed is then repaired. This approach may provide a good visual field of the tumour, but it can result in cosmetically unsatisfying results if the nail bed is injured during the procedure or if suturing is performed without care.
To minimise postoperative pain and nail bed injury, a nail-sparing and sub-nail bed approach can be used. This approach allows for the excision of the tumour without removing the nail plate by dissecting beneath the nail bed and germinal matrix. The nail plate plays a crucial role in protecting the underlying structures of the nail bed, germinal matrix, and bone. Removing the nail plate increases the risk of infection and postoperative pain.
MRI with gadolinium is the most effective imaging technique for reaching a definitive diagnosis and evaluating the extent of the condition. X-rays can also be used to visualise the erosion of the underlying bone.
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Nail-preserving excision
Glomus tumours are nodules that arise from glomus cells in the arterial portion of the glomus body, or the Sucquet-Hoyer canal. They are usually found on the nail bed or palm of a young adult and can be extremely painful, particularly after a change in temperature or pressure.
In one case, a 38-year-old female experienced pain in her second toe that increased in frequency and intensity over time, worsening when her toe came into contact with cold water. A colour duplex ultrasound revealed a hypervascular hypoechoic nodule measuring 0.5 cm at the nail bed of the affected toe. The surgery was performed under digital nerve block anaesthesia, and the patient's pain improved postoperatively without any complications.
The proximal nail fold is lifted inward using a skin hook, and the proximal end of the nail plate is gently raised to expose the nail bed. A comprehensive examination of the exposed nail bed and its surrounding matrix is conducted. A longitudinal incision is made in the nail bed, preserving the distal portion of the nail. After the tumour is excised, the nail bed is repaired, and the nail is repositioned and secured with a simple suture.
The transungual nail-preserving approach is a valuable technique for treating glomus tumours while maintaining nail integrity. It offers a favourable outcome and helps prevent nail deformity, which is a common occurrence with conventional surgical excision.
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Post-operative care
Glomus tumours are uncommon, and their occurrence in the foot is even rarer. They are benign neuromyoarterial tumours that usually develop on the nail bed or palm of a young adult. The tumour is typically a solitary, reddish-blue nodule that causes severe pain, especially when exposed to changes in temperature or pressure.
After the surgical excision of a glomus tumour, it is important to follow the doctor's instructions carefully to ensure proper healing and prevent complications. Here are some general guidelines for post-operative care:
- Keep the wound clean and dry: Wash your hands before and after touching the wound to prevent infection. You may be advised to cover the wound with a sterile dressing until it heals.
- Pain management: Your doctor may prescribe pain medication to manage post-operative pain. Take the medication as directed. It is typical to experience pain relief after the surgery.
- Elevate your foot: Keep your foot elevated as much as possible during the initial healing phase. This will help reduce swelling and promote healing.
- Avoid strenuous activity: Refrain from physical activities that put pressure or strain on the affected toe. Follow your doctor's advice on when it is safe to resume normal activities, including exercise.
- Follow-up appointments: Attend your scheduled follow-up appointments to monitor your recovery progress. During these appointments, your doctor will assess the wound, remove any stitches if necessary, and address any concerns or complications.
- Watch for complications: Be aware of any signs of infection, such as redness, swelling, or discharge from the wound. Contact your doctor immediately if you experience severe pain, fever, or other unusual symptoms.
- Nail care: If nail preservation was part of the surgery, take extra care to protect your nail during the healing process. This may include using a synthetic nail shield to prevent nail deformity and improve nail appearance.
- Long-term monitoring: Glomus tumours can recur, although it is uncommon. Stay vigilant, and inform your doctor if you notice any new symptoms or changes in the affected area.
It is important to follow the specific instructions provided by your medical team, as they may have additional or different recommendations based on your individual needs and the specifics of your surgery.
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Tumour recurrence
Glomus tumours are benign neoplastic lesions that arise from the glomus cells in the arterial portion of the glomus body, a thermoregulatory microvascular apparatus. They are usually found on the nail bed or palm of a young adult and can be extremely painful, particularly following changes in temperature or pressure. Glomus tumours of the toes are uncommon and often missed, which can cause delays in diagnosis and treatment.
The rate of tumour recurrence for glomus tumours of the toe is lower than that of other types of tumours, such as breast cancer or melanoma. However, it is important to monitor for recurrence, as early detection can improve outcomes. Patients who have been treated for a glomus tumour of the toe should be vigilant for any new symptoms or changes in their health and should report any concerns to their doctor.
There are several factors that can increase the risk of tumour recurrence, including the size and stage of the tumour at diagnosis, the aggressiveness of the cancer cells, and the effectiveness of the initial treatment. Additionally, certain genetic factors and lifestyle choices, such as smoking, can also influence the risk of recurrence.
To reduce the risk of tumour recurrence, it is important to follow the treatment plan recommended by your doctor and to attend all follow-up appointments. In some cases, additional treatments, such as radiation therapy or chemotherapy, may be recommended to reduce the risk of recurrence. It is also important to maintain a healthy lifestyle, including a balanced diet, regular exercise, and stress management.
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Frequently asked questions
Glomus tumours are growths that are most often found in the nail bed under the fingernails. They can also be found on the palm, wrist, and forearm. They are typically benign and appear as small, dark red or blue lesions.
Surgical excision is the only treatment for glomus tumours. The procedure is done under regional block anesthesia and is considered outpatient. Depending on the tumour's location, the nail bed may be removed, and an incision is made to expose and remove the tumour. The site is then closed, and the nail is replaced.
Yes, there is a nail-sparing and sub-nail bed approach that minimizes nail deformity. This approach elevates the nail plate and nail bed as a whole in an antegrade fashion, providing access to the tumour mass by dissecting beneath the nail bed.
