Cutaneous Clues to a Systemic Risk: Multiple Cutaneous Leiomyomas and Fumarate Hydratase Mutation

We report a 64-year-old woman with a long history of multiple painful cutaneous nodules, histologically confirmed as pilar leiomyomas, in the context of a positive family history. Genetic testing identified a pathogenic fumarate hydratase (FH) mutation, confirming hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. This case highlights the importance of recognising cutaneous leiomyomas as a potential early marker of a systemic cancer predisposition syndrome requiring genetic counselling and renal surveillance.