A number of skin tumors may present because of pain. Historically these were referred to as "tuberculum dolorosa". The kind of tumor occasionally can be suspected based on the clinical findings.


"Classic" painful skin tumors:

(1) neuroma (traumatic, Morton's)

(2) glomus tumor

(3) eccrine spiradenoma

(4) angiolipoma

(5) angioleiomyoma

(6) piloleiomyoma (arising from the musculi arrectores pilorum of skin)

(7) dermatofibroma

(8) neurilemmoma or neurofibroma

(9) tumors of the tactile nerve endings (neuroma of Pacinian corpuscles)

(10) endometriosis

(11) granular cell tumor

(12) cavernous hemangioma


"Nonclassic" painful skin tumors:

(1) metastatic carcinoma

(2) Merkel cell tumor

(3) chondrodermatitis nodularis chronic helicis

(4) silica granuloma




neuroma (traumatic, Morton's)

at site of trauma or amputation; sole of foot between metatarsal heads, usually in women

glomus tumor

purple or blue-red; may be subungual; paroxysms of radiating pain precipitated by pressure or change in temperature; pain may be extreme

eccrine spiradenoma

blue color, usually on head, neck, upper trunk and upper extremities but may occur elsewhere


subcutaneous and somewhat soft


usually on lower extremities of women but may be on trunk or head; slow growing and fairly firm; pain be associated with pressure, change in temperature, pregnancy or menses; never subungual; may visibly contract on exposure to cold


intracutaneous, pink to brown, may be multiple


usually occur on lower extremities of woman; shows the "dimple" sign on lateral compression

neurilemmoma or neurofibroma

may be associated with von Recklinghausen's syndrome; pain may radiate; pain may be precipitated by touch or moving the limb

tumors of tactile nerve endings



woman of reproductive years; may be associated with a scar on the lower abdomen

granular cell tumor


cavernous hemangioma


metastatic carcinoma

history of cancer; older age with weight loss; multiple; rapidly growing and stony hard; nonhealing ulceration

Merkel cell tumor

sun-exposed skin; often on the head and neck; middle aged to elderly adults; may be pinkish or purple

chrondrodermatitis nodularis chronic helicis

erythematous papule on ear

silica granuloma

granuloma at the site of traumatic implantation of silica


Although the type of lesion can sometimes be guessed, definitive diagnosis requires excision with histologic examination.


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