Multiple Painful Papules on the Arm: A Clue to Reed Syndrome

We report a case of multiple painful cutaneous piloleiomyomas that prompted evaluation for hereditary leiomyomatosis and renal cell carcinoma (HLRCC). A 26-year-old man presented with multiple painful erythematous-to-brown papules on the left upper arm that were exacerbated by cold exposure and emotional stress. Histopathologic examination demonstrated piloleiomyoma, prompting evaluation for HLRCC despite the absence of a personal or family history of similar lesions. The patient was counseled regarding the association between multiple cutaneous leiomyomas and HLRCC, and referred for genetic evaluation and appropriate renal surveillance. This case highlights the importance of recognizing multiple painful cutaneous leiomyomas as a potential cutaneous marker of an underlying hereditary cancer syndrome. Early recognition can facilitate timely genetic counseling, appropriate renal surveillance, and multidisciplinary management.