Skin lesions that are half keloid and half smooth muscle fibers, symbolizing the diagnostic confusion.

Keloid or Not? How to Spot Cutaneous Leiomyomas Mimicking Keloids

Kai Mendoza in Health & Wellness September 2025 • 4 min read.

"Uncover the key differences between keloids and cutaneous leiomyomas and ensure accurate diagnosis."

Cutaneous leiomyomas are rare, benign tumors arising from the smooth muscle of the skin. While harmless, they can sometimes be mistaken for other skin conditions, most notably keloids. Keloids, on the other hand, are abnormal proliferations of scar tissue that develop after skin injuries, surgery, or trauma.

Distinguishing between these two conditions is crucial for appropriate management. Keloids typically grow beyond the original boundaries of the wound, while hypertrophic scars remain confined. But what happens when a benign tumor starts acting like a scar?

This article delves into a fascinating case study that highlights the diagnostic challenges posed by cutaneous leiomyomas mimicking keloids. We'll explore the clinical features, diagnostic approaches, and why early recognition is essential, potentially even life-saving.

The Case of the Misdiagnosed Shoulder Keloid: A Diagnostic Journey

Skin lesions that are half keloid and half smooth muscle fibers, symbolizing the diagnostic confusion.

Imagine a 23-year-old woman seeking treatment for what appears to be keloids on her left shoulder. She’s had these raised skin lesions since childhood, experiencing mild itching and discomfort. A general practitioner initially diagnosed keloids, a reasonable assumption given the appearance and location.

However, a closer look revealed something was amiss. The patient had no history of significant trauma or surgery in the affected area, and the lesions, while resembling keloids, didn't quite fit the typical presentation. This prompted a more thorough investigation, leading to a crucial decision: a skin biopsy.

Clinical Appearance: Raised skin lesions, potentially reddish-brown in color, resembling keloids.
Patient History: Absence of typical keloid triggers like significant trauma or surgery.
Location: While keloids often appear on shoulders, other locations can raise suspicion.

The biopsy results revealed something unexpected: cutaneous leiomyomas. This case underscores the importance of dermatologists conducting comprehensive evaluations. What appeared to be a straightforward case of keloids turned out to be a completely different condition with potentially significant implications.

Why Accurate Diagnosis Matters: Beyond the Cosmetic

While cutaneous leiomyomas are benign, recognizing them is clinically relevant. These tumors can be associated with hereditary leiomyomatosis and renal cell carcinoma (HLRCC), also known as Reed’s syndrome. This genetic condition increases the risk of developing uterine fibroids, skin leiomyomas, and a specific type of kidney cancer.

In the presented case, the patient was fortunate. Screening for uterine leiomyoma and renal cell carcinoma came back negative. However, early diagnosis of cutaneous leiomyomas allows for timely investigations and monitoring for potential underlying genetic conditions.

So, next time you encounter a suspected keloid, remember that it could be something else. A thorough examination, a detailed patient history, and, when necessary, a skin biopsy can make all the difference. Early recognition and accurate diagnosis aren't just about aesthetics; they can be life-saving.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5114/dr.2016.61777, Alternate LINK

Title: Cutaneous Leiomyomas Mimicking Keloids

Subject: Dermatology

Journal: Dermatology Review

Publisher: Termedia Sp. z.o.o.

Authors: Dimitre Dimitrov, Radomir Reszke, Mowafak Mohamed Hamodat, Jacek Szepietowski

Published: 2016-01-01

Everything You Need To Know

What is the difference between cutaneous leiomyomas and keloids?

Cutaneous leiomyomas are benign tumors originating from the smooth muscle of the skin. These are distinct from keloids, which are abnormal scar tissue formations. In the case study, the cutaneous leiomyomas mimicked keloids in their appearance, leading to a misdiagnosis. The key difference lies in their origin: one is a tumor, and the other is a scarring response.

What are keloids and what are their characteristics?

Keloids are abnormal scar tissue formations that grow beyond the original wound boundaries. They develop after skin injuries, surgery, or trauma. In contrast, cutaneous leiomyomas are benign tumors. The article emphasizes that while keloids often appear on the shoulders, in this specific case, the absence of typical keloid triggers, such as major trauma or surgery, should raise suspicion.

Why is a skin biopsy important in differentiating between cutaneous leiomyomas and keloids?

A skin biopsy is a crucial diagnostic tool used to differentiate between cutaneous leiomyomas and keloids. In the case study, the initial diagnosis of keloids was incorrect. The biopsy revealed the presence of cutaneous leiomyomas, underscoring the importance of such tests when clinical presentation is ambiguous. This test helps distinguish the underlying condition based on cellular structure.

Why does accurate diagnosis matter when dealing with cutaneous leiomyomas?

Accurate diagnosis is essential because cutaneous leiomyomas, although benign, can be associated with Hereditary Leiomyomatosis and Renal Cell Carcinoma (HLRCC), also known as Reed’s syndrome. This syndrome heightens the risk of developing uterine fibroids, skin leiomyomas, and a specific type of kidney cancer. Thus, recognizing these tumors early can prompt further investigation and potentially life-saving interventions.

Can you describe the case study mentioned?

The case study involves a 23-year-old woman initially diagnosed with keloids on her left shoulder. However, upon closer examination, and with the help of a skin biopsy, the lesions were identified as cutaneous leiomyomas. This misdiagnosis was made because the cutaneous leiomyomas resembled keloids in their clinical presentation. This prompted the need for thorough dermatological evaluation and highlights the potential for alternative diagnoses when clinical appearances are similar.