Derm Dx: A nodule on the forearm - Clinical Advisor

Derm Dx: A nodule on the forearm

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A 70-year-old man requests treatment for a lesion of his left forearm. The growth has been present for at least two years and has been slowly increasing in size. He gives a history of hypertension and hyperlipidemia. Examination reveals a 3-cm nodule that is not fixed to underlying tissue. Pressure elicits minimal tenderness. No similar lesions are noted elsewhere.

Angiolipomas are subcutaneous tumors that may arise on any part of the body but most frequently affect the forearm. A good percentage of these neoplasms first manifest in early adulthood and multiple growths are not uncommon.1 The lesions were first...

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Angiolipomas are subcutaneous tumors that may arise on any part of the body but most frequently affect the forearm. A good percentage of these neoplasms first manifest in early adulthood and multiple growths are not uncommon.1 The lesions were first delineated in 1960 based on histopathology, as they clinically resemble lipomas,2 although they are more likely to be tender when touched or palpated.1 Most lesions are encapsulated and all have varying degrees of vascularity. Surrounding tissue contains myelinated nerve fibers believed responsible for the pain associated with these benign tumors.1

Rare variants include the cellular3 and infiltrative4 subtypes. Surgical excision is curative, and recurrence is uncommon.

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Belcher RW, Czarnetzki BM, Carney JF, Gardner E. Multiple (subcutaneous) angiolipomas: clinical, pathologic, and pharmacologic studies. Arch Dermatol. 1974;110(4):583-585.
  2. Howard WR, Helwig EB. Angiolipoma. Arch Dermatol. 1960;82:924-931.
  3. Hunt SJ, Santa Cruz DJ, Barr RJ. Cellular angiolipoma. Am J Surg Pathol. 1990;14(1):75-81.
  4. Mayooran N, Tarazi M, O’Brien O, Hinchion J. Infiltrating angiolipoma of the chest wall: a rare clinical entity. J Surg Case Rep. 2016;2016(1).
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