What treatment do you recommend for painful large plaques of leiomyomas on the back of a patient with HLRCC syndrome when lesions are too large for excision?

Depending on the extent of discomfort, surgery may be required for debilitating leiomyoma-associated pain. In some cases, a larger exophytic nodule(s) can be isolated as the lesion(s) that are most painful and selectively excised, but broad segmental involvement is common in HLRCC, particularly on the back, and complete excision could potentially require tissue expanders or other advanced techniques. Coordination with an excellent plastic surgeon is integral, as well as patient understanding that lesions may develop again DESPITE removal of an entire painful area. The pathology of HLRCC-associated leiomyoma may show occasional mitosis and should be read by a pathologist experienced in HLRCC, lest it be overcalled leiomyosarcoma. A pain and ...