18570 A novel intraoperative technique for better visualization and excision of a glomus tumor

Abstract

Glomus tumor is an uncommon benign vascular tumor arising from the cells of the glomus body structure most commonly in the subungual region of finger digits. Magnetic resonance imaging is considered the best modality for detecting lesions as small as 2 mm, and are usually visualized as a central spot of high signal intensity surrounded by an area of lower signal intensity. Surgical excision is the standard of care and several approaches are listed: direct transungual, lateral incision close to the edge of the nail, high midlateral incision below the lateral nail fold, lateral subperiosteal, modified periungual, nail bed margin, and nail-preserving modified lateral subperiostial. Here we present a novel intraoperative technique for enhanced visualization of the tumor for improved surgical outcomes. A series of 30 patients have been evaluated with intraoperative dermoscopic evaluation of the tumor. First the digit is anesthetized with the use of a standard digital nerve block technique. Then hemostasis is improved using a modified surgical tourniquet with a non-sterile glove rolled up tightly around the operative digit. Once the nail plate has been partially removed laterally exposing the tumor, dermoscopy is used to better visualize the tumor burden. As seen in the figures, there is an enhanced visualization of the overall tumor and evaluation of surgical margins in real time. This has the potential to allow dermatologists to better determine a complete surgical excision.