Surgical Resection of Subungual Glomus Tumor after 20 Years of Misdiagnosis

Abstract

The glomus tumor is a rare benign neoplasm that originates from the glomus body, accounting for less than 2% of hand tumors. Its subungual location is classic and is characterized by the triad of intense pain, hypersensitivity to cold, and pain on pinpoint palpation. Its diagnosis is often challenging due to delays and misdiagnoses. We report the case of a 47-year-old female patient who came to our service with a small, extremely painful tumor lesion on the nail bed of the third finger of the right hand, with an evolution of more than 20 years. She was initially managed by Orthopedics and Rheumatology services with a diagnosis of Raynaud´s Disease, without improvement. Evaluation in Angiology raised suspicion of a glomus tumor. Complete surgical resection was performed with histopathological confirmation. The postoperative course was uneventful, with total pain remission and excellent aesthetic outcome. We consider that glomus tumor should be included in the differential diagnosis of chronic and focal nail pain. A high index of clinical suspicion is essential to avoid prolonged delays in diagnosis. Complete excision surgery is the treatment of choice, with very high cure rates and low recurrence. The role of the Angiology and Vascular Surgery specialist is crucial in the management of this pathology.