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September 15, 2008

Painful Red Spots on the Cheek of a Young Man—Diagnosis

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Arch Dermatol. 2008;144(9):1217-1222. doi:10.1001/archderm.144.9.1218-a

At low power, the skin biopsy specimen showed intradermal collections of elongated cells (Figure 2), which at high power (Figure 3) were cigar shaped with eosinophilic cytoplasm, a typical feature of leiomyomas.

Pilar leiomyomas are derived from arrector pili muscles1 and most commonly appear in early adulthood. The red or dusky-brown dermal papules and nodules are said to be clinically distinctive. They are multiple in approximately 80% of patients.2 Their morphological features are often heterogeneous, and when the lesions are multiple, they may show nevoidal,3 segmental, and zosteriform2 clinical subtypes, although the histologic findings are identical. The limbs and trunk are commonly affected; however, there are published reports of facial involvement.4 Unlike nevoidal and zosteriform subtypes, segmental subtypes have been reported in association with uterine leiomyomas.5

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