Multiple Cutaneous Leiomyomas of the Shoulder: Investigating Chronic Pain and Reed's Syndrome Association

Cutaneous leiomyomas are rare benign tumors originating from the arrector pili muscles, often presenting as firm, painful nodules. In this report, we describe a man in his 40s presenting with multiple progressively enlarging painful nodules on the right shoulder first noticed about five years ago. The pain was described to be paroxysmal, worsened by cold exposure and physical pressure, and described as burning and aching. A 4-mm punch biopsy confirmed the diagnosis of multiple cutaneous leiomyomas, showing fascicles of spindle cells and elongated cigar-shaped nuclei in a palisading pattern. The patient was treated with oral nifedipine for pain control, with topical hyoscine hydrobromide (9%) recommended if symptoms persisted. He was advised to follow up for worsening pain and screening for potential Reed's syndrome. Here, we emphasize the importance of considering cutaneous leiomyoma in the differential diagnosis of painful dermal nodules and the significance of evaluating for possible syndromic associations.