Skip to content

Clinicians › Hand

Glomus Tumour

63 citationsUpdated Oct 2026
Illustration: hand

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Glomus tumors are rare vascular neoplasms, encountered in 0.26% of patients (8 of 3014) referring for hand surgery over a 10-year period [15]. They represent one of the most painful clinical conditions confirmed by comprehensive clinical assessment [2]. Although symptoms and signs are relatively sensitive and specific when used in combination [4], the diagnosis is primarily clinical because imaging techniques do not provide a specific image of the tumor [12]. Consequently, a high index of suspicion is of primary importance when dealing with these lesions [3, 7]. These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis [1].

Clinicians must be aware that glomus tumors can present with severe morbidity despite subtle clinical signs [11]. Multiple digital glomus tumors are a definite entity, occurring in seven of 28 patients in a specific series [16]. Patients should be counseled before surgery regarding the possibility of multiple glomus tumors [7]. Clinicians should search for synchronous glomus tumors during excision to avoid recurrence or persistence of symptoms due to undiscovered multiple lesions [20]. Familiarity with extradigital glomus tumors will enable hand surgeons to provide patients with long-term relief from this unusual problem [8].

Glomus tumours are often misdiagnosed and are intervened with different treatment options before being surgically intervened [14]. A retrospective study of 11 patients with glomus tumors of the hand showed a mean age of 36.27 years and a mean follow-up of 34.40 months [46]. Although glomus tumors in children are extremely rare, most are benign and can be completely cured through surgical excision [70]. The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes [9]. Although some reports suggest that glomus tumours of uncertain malignant potential do not metastasise, a case demonstrates an unfavourable and aggressive clinical course [17]. The treatment of choice for glomangiosarcomas is wide local excision [42].

Anatomy & Pathophysiology

Glomus Body Anatomy and Physiology

The glomus body is a specialized arteriovenous anastomosis located in the dermis, specifically within the stratum reticularis [43, 45]. It functions in thermoregulation by controlling skin blood flow [43, 64]. Structurally, the glomus body consists of an afferent arteriole derived from small dermal arterioles [64]. Round, epithelial-appearing glomus cells, which are specialized cells closely related to pericytes and myocytes, surround the anastomosis alongside smooth muscle fibers and neuroreticular elements [45]. The entire glomic complex is encompassed by lamellated collagenous tissue containing small nerves and blood vessels, with unmyelinated nerve fibers typically found within and surrounding the body [45].

Tumor Histology and Origin

Glomus tumors are benign, highly organized, and well-differentiated neoplasms composed of modified smooth muscle cells that resemble normal glomus body cells [43]. They are considered hamartomatous proliferations originating from normal glomus cell populations within the glomus neuro-myo-arterial system [64, 21]. These rare tumors represent approximately 5% of soft tissue tumors of the hand, though other sources cite a range of 1–2% [21, 64]. Glomus tumors are usually small (less than 1 cm) and solitary, although lesions between 3 cm and 5 cm in deep locations and multiple glomus tumor lesions have been described [43]. Glomangiomas are also benign and develop from the glomus body [44].

Anatomical Distribution

Glomus tumors most commonly occur in the fingers, with the distal phalanx, particularly the subungual region, being the most frequent site [43, 31]. Hand glomus tumors show a predominance on the ring finger [71]. While extradigital sites are not uncommon and account for 11–65% of all cases, they are almost invariably subcutaneous [43, 64]. The forearm is the most common extradigital location, whereas glomus tumors about the wrist area are rare [39, 40]. These tumors can arise at sites where normal glomus bodies may be sparse or absent, including muscle, bone, blood vessels, and nerve [43]. Extradigital glomus tumors have been reported to be more common in men, although most subungual lesions occur in women [64].

Pathophysiology of Pain

The characteristic clinical presentation includes exquisite superficial tenderness and paroxysms of pain often associated with temperature change or cold [43]. The classic triad consists of paroxysmal pain, localized tenderness, and cold intolerance [64]. Glomus tumors present as small red-blue nodules initially accompanied by a paroxysm of pain radiating away from the lesion, with extreme point tenderness and cold insensitivity being characteristic features [45]. The precise mechanism of pain production is not yet established [43]. However, glomus bodies lie in a rich neural bed under neurologic control, and glomus cells are adjacent to this neural bed, which may explain the severe pain and hypersensitivity [43, 64]. A pain-associated vasoactive peptide, substance P, has been observed within nerve fibers in glomus tumors [43]. Additionally, mast cells of the glomus tumor may play an important role in mediating pain [64]. Occasionally, a glomus tumor can cause pain by directly compressing forearm nerves [64].

Etiology and Risk Factors

The etiology of glomus tumors is not clear [64]. An autosomal dominant pattern of inheritance has been reported [64]. A history of injury is cited as a factor in development, and although trauma as a causative factor has not been confirmed, several retrospective studies mention preceding trauma or injury to the area where the tumor developed [64, 35]. In a study of 56 cases of extradigital glomus tumors over a 20-year period, 20% of cases had associated trauma prior to symptom onset [35]. In another study, three out of eight patients with glomus tumors of the digits gave a history of preceding trauma [35]. The history of trauma is considered an important cause of glomus tumors [72].

Clinical Presentation and Diagnostic Challenges

Glomus tumors are among the most painful clinical conditions confirmed by comprehensive clinical assessment [2]. Symptoms and signs are relatively sensitive and specific when used in combination [4]. Despite this, glomus tumors of the hand are associated with prolonged diagnostic delay regardless of tumor location [5]. Early occult lesions may not be revealed by physical examination due to barely detectable symptoms [24]. These subcutaneous, mostly subungual nodules have a disproportionate negative impact despite their small size [71]. Symptoms are often unclear even when significant pain is present, leading to late diagnosis [21]. Chronic pain from glomus tumors evolves in the upper limb and causes disability and handicap [21]. Though benign, these tumors can cause decades of severe pain if misdiagnosed [10]. Glomus tumors are often misdiagnosed and subjected to different treatment options before surgical intervention [14]. Subungual glomus tumours have a characteristic clinical presentation [36]. Diagnosis is supported by a combination of magnetic resonance imaging and clinical examination [54]. Clinical evaluation of the hand requires combining patient history with a careful physical examination to pinpoint possible pathologic processes [47].

Classification

Pathological Morphology: Glomus tumors are classified into three distinct histological subtypes: solid glomus tumor, glomangioma, and glomangiomyoma [106]. Solid glomus tumors consist predominantly of glomus cells [106]. Glomangiomas feature glomus cells surrounding a large number of blood vessels [106]. Glomangiomyomas contain a large number of vascular smooth muscle cells [106].

Glomangioma Characteristics: Glomangiomas represent the vascular variant of the glomus tumor [73]. They are more common in extradigital sites of the hand and forearm compared to typical glomus tumors [73]. These lesions usually occur as multiple lesions [73]. Clinically, glomangiomas are usually painless and often present as areas of discoloration, lacking the typical triad of pain, distinct local tenderness, and sensitivity to cold found in glomus tumors [73]. Histologically, they are characterized by prominent cavernous spaces with interspersed glomus cells [73]. They are poorly circumscribed and resemble a cavernous haemangioma [73]. Glomangiomas may exhibit pseudomalignant features such as poor encapsulation, cellular pleomorphism, and mitosis [73].

Other Considerations: Malignant glomus tumors are rare and mandate case presentation and longitudinal analysis to guide surgical management [9]. Glomus tumors of uncertain malignant potential have been reported to demonstrate an unfavourable and aggressive clinical course despite some reports suggesting they do not metastasise [17].

Clinical Presentation

Pain and Symptom Characteristics

Glomus tumors present with focal, often debilitating pain [32] that is variable in intensity [3]. The hallmark symptom is paroxysmal pain usually elicited by tactile stimulation [57]. Symptoms are frequently unclear despite significant pain [21], and misdiagnosis can result in decades of severe suffering [10]. In some cases, the presentation mimics Type II Complex Regional Pain Syndrome (CRPS) [25] or involves atypical shoulder radiation [10]. The mean duration of symptoms prior to diagnosis is 7.2 years [32].

Physical Examination and Clinical Signs

Diagnosis relies on a delicate amalgam of symptoms, signs, and investigations [27], with a classic patient history and meticulous physical examination paramount enough to override inconclusive advanced imaging [10]. Clinical diagnosis is feasible based on history and examination alone [18], as symptoms and signs are relatively sensitive and specific when used in combination [4]. Superficial lesions are readily apparent on inspection due to characteristic blue-red coloration [57]. Subungual glomus tumours exhibit a characteristic clinical presentation [36].

Demographics and Epidemiology

Glomus tumors occur most commonly between 20 and 40 years of age with no sex predilection [57]. They represent approximately 5% of soft tissue tumors of the hand [21]. In a 10-year hand surgery referral series, the disease was encountered in 0.26% of patients (8 of 3014) [15]. A retrospective surgical pathology database indicated that the upper extremity was involved in 12/25 (48%) of cases, while the lower extremity was involved in 12/25 (48%) [32].

Anatomical Location

Tumors develop within the glomus neuro-myo-arterial system, mostly in the hand at the subungual region [21]. In the vast majority of cases, the tumor arises in the subungual region of the digits [57]. Glomus tumors are occasionally found in the palm and foot [57] and may appear anywhere, even at sites where the glomus body is normally absent [57]. The forearm is the most common extradigital location [39], with the frequency of extradigital cases in reported series varying from 11% to 65% [39]. One case (4%) in a retrospective database was located within the trachea [32].

Multiplicity and Associated Conditions

Multiple lesions occur in approximately 10% of cases [57]. Multiple digital glomus tumors are a definite entity, occurring in seven of 28 patients in one series [16]. Glomus tumor must be included in the differential diagnosis for neurofibromatosis patients presenting with a painful lesion of the hand or finger [51]. Specifically, in patients with type I neurofibromatosis presenting with a painful subcutaneous lesion, glomus tumor must be considered [53].

Diagnostic Challenges and Delay

Glomus tumors are associated with prolonged diagnostic delay regardless of tumor location [5]. As an uncommon soft tissue neoplasm, they may be easily dismissed by clinicians, resulting in prolonged periods before correct diagnosis [13]. A significant proportion of patients are initially diagnosed with psychiatric disorders [57]. Early diagnosis is critical to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses [93]. Diagnostic delay implies treatment delay, leading to amplified suffering and real disability due to high-intensity pain [19]. A high index of suspicion is necessary when tumors arise from deeper structures at unusual anatomical sites [57], highlighting the continued importance of clinical suspicion [1].

Investigations

Clinical Diagnosis: Clinical suspicion remains critical for diagnosing glomus tumors, particularly when magnetic resonance imaging is negative [1]. A high index of suspicion is required due to variable pain presentation [3], as these tumors are easily dismissed by clinicians, resulting in prolonged diagnostic delays [13]. Diagnosis is confirmed by comprehensive clinical assessment [2], where a classic patient history and meticulous physical examination can override inconclusive advanced imaging [10].

MRI: MRI is the most sensitive diagnostic tool for glomus tumors [96]. In a series of six patients with hand glomus tumors, MRI depicted the tumors in excellent detail, facilitating diagnosis in atypical presentations and serving as a valuable noninvasive means for early diagnosis of occult tumors [31]. MRI with a marker placed in the region of point tenderness is the best method for identifying small glomus tumors [32]. Characteristic imaging features include a small circumscribed mass at the site of point tenderness showing high T2 signal, uniform enhancement after gadolinium administration, and diffuse contrast medium enhancement [32]. MRI has also aided diagnosis in unusual locations, such as the fingertip [61]. However, MRI is not reliable for diagnosing intravenous glomus tumors [97]. Failure to diagnose glomus tumors on MRI is associated with smaller tumor size, atypical pathology, and atypical location [92]. In four cases where MRI was negative, histology confirmed glomus tumors; the lack of delineation was attributed to their small size (2–3 mm) [50].

Ultrasound: Ultrasonography shows lesions as well-circumscribed with marked vascularity on color Doppler evaluation [32]. The diagnosis is suggested by a small circumscribed mass at the site of point tenderness demonstrating marked vascularity on Doppler [32]. Ultrasound confirmed the presence and precise location of a subungual glomus tumor before surgery [66]. While user-dependent, ultrasound may be non-inferior for a sonographer familiar with subungual imaging [58]. In one case, ultrasound identified a well-defined cystic lesion with internal debris measuring 14 - 6 - 10 mm within the subcutaneous layer [35]. In the same case, the lesion was avascular, incompressible, and appeared similar to a neuroma on ultrasound [35].

Other Imaging Modalities: Various methods proposed to augment physical examination include plain x-rays, arteriograms, thermograms, and high-resolution real-time ultrasound [31]. These modalities have limitations regarding radiation exposure, operator-dependent technique, or both [31]. Three-dimensional reconstruction using multidetector computed tomography angiography illustrated the tumor, vascular branches, and bony components in a single image [68]. Imaging studies can be of little utility in distinguishing glomus tumors from other lesions, such as giant cell tumor of the tendon sheath [98].

Treatment

Non-Operative

The provided evidence base does not support conservative management as a definitive treatment strategy for glomus tumors. Surgical intervention is the established standard of care, with no evidence cited regarding the efficacy of weight loss, physical therapy, NSAIDs, or injections in curing the condition.

Operative

Indications: Complete surgical excision is the reference treatment and treatment of choice for glomus tumors [21, 57]. Once identified, these tumors can be effectively treated with complete excision [6]. The procedure is curative, providing immediate relief [10] and dramatically curing the condition [2]. Excision relieves symptoms in most patients [20], with an immediate effect on pain and hypersensitivity [25]. In specific cases, excision results in complete pain relief and resolution of clinical symptoms [23]. Most benign glomus tumors in children can be completely cured through surgical excision [70].

Surgical Approach / Technique: Excision of glomus tumors is curative with minimal risk of recurrence [34]. A transungual approach has resulted in the complete improvement of symptoms without recurrences [33]. The Microscopic Transungual Surgical Approach has potential efficacy in treating these tumors [99]. In a study of subungual glomus tumors, no new nail deformity was found with the transungual approach, contrary to reported literature [41]. However, neither a nail-sparing approach nor microscopic excision lowered the incidence of nail deformities in a multicentre study [69]. The current evidence on glomus tumors is limited to retrospective case series and literature reviews, with no studies comparing different surgical approaches [26].

Other Considerations: Local recurrence is rare and usually indicates inadequate excision [57]. No risk factors significantly predicted recurrence in a multicentre study of digital glomus tumours [69]. Multiple digital glomus tumors are a definite entity, occurring in seven of 28 patients in a 1979 series [16]. Multiple lesions occur in approximately 10% of cases [57]. Although some reports suggest that glomus tumours of uncertain malignant potential do not metastasise, a 2012 case demonstrated an unfavourable and aggressive clinical course [17]. Malignant transformation appears to be such a rare phenomenon that it can be disregarded from the clinical point of view [57].

Complications

Diagnostic Delay and Misdiagnosis: Glomus tumors are frequently dismissed by clinicians, resulting in a prolonged period before correct diagnosis is established [13]. This diagnostic delay often leads to misdiagnosis for months or even years [21]. The subsequent treatment delay amplifies suffering and can cause real disability due to high-intensity pain [19]. Symptoms are often unclear despite significant pain, degrading the patient's quality of life during the misdiagnosis period [21]. This degradation in quality of life is considered the most disabling factor of the disease [21]. A subungual tumor with a 15-year delay and atypical shoulder radiation highlights the need for heightened clinical suspicion [10]. Severe morbidity can occur with subtle clinical signs in rare presentations [11].

Atypical Presentation and Diagnostic Challenges: While the classic presentation is a painful subcutaneous nodule in a subungual or digital pulp location, atypical presentations are well documented [31]. Early occult lesions may not be revealed on physical examination, making localization for extirpation difficult [31]. Glomus tumors can present as Type II CRPS, such as a periosteal glomus tumor at the metacarpal base [25]. Extradigital cases account for 11–65% of all glomus tumor cases and are reported to be more common in men, although most subungual lesions occur in women [64]. The forearm is the most common extradigital location [64]. A glomus tumor can occasionally cause pain by directly compressing the forearm nerves [64].

Imaging and Localization: Various diagnostic methods have been proposed to augment physical examination, including plain x-rays, arteriograms, thermograms, and high-resolution real-time ultrasound [31]. All these methods have limitations regarding radiation exposure, operator-dependent technique, or both [31]. Magnetic resonance imaging (MRI) with a marker placed in the region of point tenderness is the best method for identifying small glomus tumors [32]. These tumors exhibit high T2 signal and uniform enhancement after gadolinium administration [32]. MRI proved valuable as a noninvasive and accurate means for the early diagnosis of occult glomus tumors, facilitating diagnosis in patients with atypical presentation [31]. The continued importance of clinical suspicion is highlighted, particularly when the tumor is not diagnosed on MRI [1].

Other Considerations: Glomus tumors are benign neoplasms arising from glomus bodies, which are specialized arteriovenous anastomoses serving a thermoregulatory function [43]. The first clinical description is credited to Wood in 1812, with the term "glomus" coined by Masson in 1924 [43]. These tumors are highly organized, well-differentiated, and benign [43]. The mechanism of pain production is not fully established, but the presence of substance P within nerve fibers and the neurologic control of glomus bodies may be relevant [43]. Glomus tumors account for 1-2% of soft tissue tumors of the hand [64]. In a Mayo clinic series, they accounted for 1.6% of 500 consecutive primary soft tissue tumours of the extremities [73]. Mean tumor size was 13 mm, with a mean duration of symptoms of 7.2 years [32]. The upper extremity was involved in 48% of tumors, the lower extremity in 48%, and one case (4%) was within the trachea [32]. Essentially, all glomus tumors are benign and are adequately treated by excision [45]. Infrequent cases of recurrence are probably the result of incomplete excision or missed multiple tumors [45]. On removal of the tumor, symptoms are usually completely resolved [45].

Recovery

Other Considerations: Complete surgical excision of glomus tumors is curative [2]. Surgical excision is associated with minimal risk of recurrence [34]. Excision through a transungual approach resulted in complete improvement of symptoms without recurrences [33]. Surgical management can improve the quality of life in patients treated for glomus tumors of the upper limb [21]. Multiple digital glomus tumors are a definite entity, occurring in seven of 28 patients in a reported series [16].

Key Evidence

  • [L4] These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis. [1] (10.1016/j.jhsa.2014.12.002)
  • [Paper] Glomus tumor is one of the most painful clinical conditions confirmed by comprehensive clinical assessment and cured dramatically by complete surgical excision. [2] (10.4103/jfmpc.jfmpc_446_20)
  • [Paper] Glomus tumors can present with variable pain, and a high index of suspicion is needed for diagnosis. [3] (10.7759/cureus.30038)
  • [Paper] Although glomus tumours are uncommon tumours, symptoms and signs are relatively sensitive and specific when used in combination. [4] (10.5999/aps.2013.40.5.492)
  • [Paper] Glomus tumors of the hand are associated with prolonged diagnostic delay regardless of tumor location. [5] (10.7759/cureus.107434)
  • [Paper] Once identified, glomus tumors can be effectively treated with complete excision. [6] (10.7759/cureus.86227)
  • [L5] A high clinical suspicion is of primary importance when dealing with these lesions, and patients should be counseled before surgery regarding the possibility of multiple glomus tumors. [7] (10.1016/j.jhsa.2004.09.008)
  • [L4] Familiarity with extradigital glomus tumors will enable hand surgeons to provide patients with long-term relief from this unusual problem. [8] (10.1016/j.jhsa.2017.07.025)
  • [L4] The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes. [9] (10.1177/1558944715614874)
  • [Paper] [10] (10.1002/ccr3.71849)
  • [Paper] We report this case for the rare presentation of glomus tumour (severe morbidity with subtle clinical signs). [11] (10.4103/0974-2077.146683)
  • [L5] The diagnosis of glomus tumor is primarily clinical because imaging techniques do not give a specific image of the tumor. [12] (10.1016/s1058-2746(02)00029-0)
  • [L4] Glomus tumour is an uncommon soft tissue neoplasm that commonly occurs in the extremities and may be easily dismissed by clinicians, resulting in a prolonged period before the right diagnosis is made. [13] (10.1186/s13018-023-04234-1)
  • [L4] Glomus tumours are often misdiagnosed and are intervened with different treatment options before being surgically intervened. [14] (10.4103/jwas.jwas_171_22)
  • [L4] Glomus tumor is a rare disease, encountered in 0.26% of patients (8 of 3014) referring for hand surgery over a 10-year period. [15] (10.1097/bth.0b013e3181c767d4)
  • [L4] Multiple digital glomus tumors are a definite entity, occurring in seven of 28 patients in this series. [16] (10.1016/s0363-5023(79)80076-3)
  • [L5] Although some reports suggest that glomus tumours of uncertain malignant potential do not metastasise, this case demonstrates an unfavourable and aggressive clinical course. [17] (10.1136/bcr-2012-007618)
  • [Paper] Diagnosis of glomus tumours can be made clinically based on history taking and clinical examination. [18] (10.5704/moj.1703.020)
  • [Paper] Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases. [19] (10.47162/rjme.62.1.23)
  • [Case_report] Excision of the tumor relieves symptoms in most patients, but clinicians should search for synchronous glomus tumors during excision to avoid recurrence or persistence of symptoms due to undiscovered multiple lesions. [20] (10.1016/j.jhsa.2013.07.024)
  • [L4] [21] (10.1016/j.main.2014.07.001)
  • [Paper] Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. [24] (10.5999/aps.2013.40.4.392)
  • [Case_report] Excision of symptomatic glomus tumors has an immediate effect on pain and hypersensitivity. [25] (10.1177/1558944719895618)
  • [L4] The evidence on glomus tumor is limited to retrospective case series and literature reviews, with no studies comparing different surgical approaches. [26] (10.1016/j.jhsa.2011.10.026)
  • [Paper] The diagnosis of a glomus tumor is a delicate amalgam of symptoms, signs, and investigations. [27] (10.4103/idoj.idoj_1186_24)
  • [L4] [31] (10.1016/0363-5023(92)90353-q)
  • [L4] [32] (10.1007/s00256-010-1067-1)
  • [Paper] Excision of glomus tumors through a transungual approach resulted in the complete improvement of symptoms without recurrences. [33] (10.1016/j.jpra.2020.09.004)
  • [Paper] Surgical excision of glomus tumors was curative with minimal risk of recurrence. [34] (10.4103/idoj.idoj_786_24)
  • [L4] [35] (10.1177/1758573216640190)
  • [Paper] Subungual glomus tumours have characteristic clinical presentation. [36] (10.4103/0974-2077.123401)
  • [L5] The frequency of extradigital cases reported in these series varied from 11% to 65%, with the forearm noted to be the most common extradigital location. [39] (10.1016/s0266-7681(05)80105-6)
  • [L4] Glomus tumors about the wrist area are rare. [40] (10.1016/s0363-5023(83)80095-1)
  • [Paper] Contrary to reported literature, we did not find the development of any new nail deformity with this approach. [41] (10.4103/0019-5413.159611)
  • [L5] The treatment of choice for glomangiosarcomas is wide local excision. [42] (10.1016/s0363-5023(97)80057-3)
  • [L5] [43] (10.1016/s1058-2746(99)90162-3)
  • [L4] In principle, glomangiomas are benign; they develop from the glomus body and occur especially in the fingers (subungual). [44] (10.1007/bf00932451)
  • [L5] [45] (10.1016/s0363-5023(09)91114-5)
  • [Paper] The retrospective study of 11 patients with glomus tumors of the hand showed a mean age of 36.27 years and a mean follow-up of 34.40 months. [46] (10.11604/pamj.2016.24.262.8154)
  • [L4] The four cases in which the MRI was negative all proved histologically to be glomus tumours, and the lack of delineation was attributed to their small size (2–3 mm). [50] (10.1016/j.jhsb.2005.06.009)
  • [L3] Glomus tumor should be included in the differential diagnosis in neurofibromatosis patients who present with a painful lesion of the hand or finger. [51] (10.1016/j.jhsa.2013.05.025)
  • [Paper] In the patient with type I neurofibromatosis who presents with a painful subcutaneous lesion, the diagnosis of glomus tumor must be considered. [53] (10.1097/gox.0000000000000144)
  • [L5] A combination of magnetic resonance imaging and clinical examination is used to support the diagnosis. [54] (10.1016/j.jhsa.2006.05.018)
  • [L5] [57] (10.1067/mse.2000.108961)
  • [Paper] US is user-dependent and may be non-inferior for a sonographer familiar with subungual US. [58] (10.1159/000530397)
  • [L5] Magnetic resonance imaging has been shown to help in the diagnosis of a glomus tumor in an unusual location in a fingertip. [61] (10.1016/0363-5023(90)90072-y)
  • [Paper] [64] (10.1155/2014/619490)
  • [L5] Ultrasonography confirmed the presence and precise location of a subungual glomus tumour before surgery. [66] (10.1016/0266-7681(93)90235-8)
  • [Paper] Three-dimensional reconstruction illustrated the tumor, vascular branches, and bony components in a single image. [68] (10.5021/ad.2015.27.2.226)
  • [L4] No risk factors significantly predicted recurrence, and neither a nail-sparing approach nor microscopic excision lowered the incidence of nail deformities. [69] (10.1177/1753193418774176)
  • [Paper] Although glomus tumors in children are extremely rare, most are benign and can be completely cured through surgical excision. [70] (10.1002/ccr3.72907)
  • [L4] These subcutaneous, mostly subungual, nodules, with predominance on the ring finger, have a disproportionate negative impact despite their small size. [71] (10.1016/j.hansur.2017.04.002)
  • [Paper] The history of trauma is an important cause of GTs, and the most common site of extra-subungual tissue is the knee, especially in young adults. [72] (10.21037/atm-20-6998)
  • [L4] [73] (10.1054/jhsb.1998.0013)
  • [L4] Failure to diagnose glomus tumors on MRI is associated with smaller tumor size, atypical glomus tumor pathology, and atypical location. [92] (10.1016/j.jhsa.2014.06.096)
  • [Paper] Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses. [93] (10.4103/jfmpc.jfmpc_88_19)
  • [Paper] MRI is the most sensitive diagnostic tool for glomus tumors. [96] (10.11604/pamj.2017.26.155.11899)
  • [L5] Unlike extradigital glomus tumors, magnetic resonance imaging is not reliable in diagnosing intravenous glomus tumors. [97] (10.1177/1558944716675296)
  • [Case_report] Imaging studies can be of little utility in distinguishing glomus tumors from other lesions like giant cell tumor of the tendon sheath. [98] (10.1016/j.jhsa.2012.02.035)
  • [Paper] Our study suggests the potential efficacy of the Microscopic Transungual Surgical Approach in treating glomus tumors. [99] (10.3389/fmed.2025.1607299)
  • [Paper] [106] (10.1016/j.abd.2023.03.005)

See Also

References

[1] Characteristics of Glomus Tumors in the Hand Not Diagnosed on Magnetic Resonance Imaging. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.002

[2] Digital glomus tumor: An experience of 57 cases over 20 years. Journal of Family Medicine and Primary Care. 2020. DOI: 10.4103/jfmpc.jfmpc_446_20

[3] Hand and Foot Glomus Tumors: Significance of MRI Diagnosis Followed by Histopathological Assessment. Cureus. 2022. DOI: 10.7759/cureus.30038

[4] Where is the Lesion? Glomus Tumours of the Hand. Archives of Plastic Surgery. 2013. DOI: 10.5999/aps.2013.40.5.492

[5] Diagnostic Delay and Clinical Characteristics of Glomus Tumors in the Hand: A Case Series of 11 Patients. Cureus. 2026. DOI: 10.7759/cureus.107434

[6] Management of Glomus Tumors: Experience From a Tertiary Care Centre in India. Cureus. 2025. DOI: 10.7759/cureus.86227

[7] Multiple occurrences of different histologic types of the glomus tumor. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.09.008

[8] An Extradigital Glomus Tumor of the Median Antebrachial Vein. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.07.025

[9] Malignant Glomus Tumors of the Hand. HAND. 2016. DOI: 10.1177/1558944715614874

[10] Unmasking the Silent Glomus Tumor of the Index Finger—A Case Report and Literature Review. Clinical Case Reports. 2026. DOI: 10.1002/ccr3.71849

[11] Unusual location of glomus tumour on the right ring finger. Journal of Cutaneous and Aesthetic Surgery. 2014. DOI: 10.4103/0974-2077.146683

[12] Extradigital glomus tumor of the triceps tendon as a cause of elbow pain: a case report. Journal of Shoulder and Elbow Surgery. 2003. DOI: 10.1016/s1058-2746(02)00029-0

[13] Glomus tumour: an institutional experience of 31 cases. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04234-1

[14] Glomus Tumour of Hand––A Commonly Misdiagnosed Pathology. Journal of West African College of Surgeons. 2022. DOI: 10.4103/jwas.jwas_171_22

[15] Diagnosis and Management of Glomus Tumors of the Hand. Techniques in Hand & Upper Extremity Surgery. 2010. DOI: 10.1097/bth.0b013e3181c767d4

[16] Multiple digital glomus tumors. The Journal of Hand Surgery. 1979. DOI: 10.1016/s0363-5023(79)80076-3

[17] Clinically malignant atypical glomus tumour. BMJ Case Reports. 2012. DOI: 10.1136/bcr-2012-007618

[18] Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis?. Malaysian Orthopaedic Journal. 2017. DOI: 10.5704/moj.1703.020

[19] Clinical, histopathological and immunohistochemical features of glomus tumor of the nail bed. Romanian Journal of Morphology and Embryology. 2021. DOI: 10.47162/rjme.62.1.23

[20] Multiple Intraneural Glomus Tumors on a Digital Nerve: Case Report. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.07.024

[21] Improvement in quality of life after surgery for glomus tumors of the fingers. Chirurgie de la Main. 2014. DOI: 10.1016/j.main.2014.07.001

[23] Glomus tumor of the thenar eminence in neurofibromatosis type 1: case report and literature review. Translational Medicine @ UniSa. 2015.

[24] Glomus Tumors: Symptom Variations and Magnetic Resonance Imaging for Diagnosis. Archives of Plastic Surgery. 2013. DOI: 10.5999/aps.2013.40.4.392

[25] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[26] Subungual Glomus Tumor. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.026

[27] An Intriguing Case of Extra-Digital Glomus Tumor on the Palm. Indian Dermatology Online Journal. 2025. DOI: 10.4103/idoj.idoj_1186_24

[31] Glomus tumor imaging: Use of MRI for localization of occult lesions. The Journal of Hand Surgery. 1992. DOI: 10.1016/0363-5023(92)90353-q

[32] Imaging features of glomus tumors. Skeletal Radiology. 2010. DOI: 10.1007/s00256-010-1067-1

[33] Outcome of transungual surgical approach with synthetic nail shield in the treatment of digital glomus tumors: A retrospective study. JPRAS Open. 2020. DOI: 10.1016/j.jpra.2020.09.004

[34] Clinico-epidemiological Characteristics and Long-term Surgical Outcomes in Patients with Glomus Tumor: A Retrospective Study. Indian Dermatology Online Journal. 2025. DOI: 10.4103/idoj.idoj_786_24

[35] Glomus tumour of the elbow: an unusual complication of surgery. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216640190

[36] Transungual surgical excision of subungual glomus tumour. Journal of Cutaneous and Aesthetic Surgery. 2013. DOI: 10.4103/0974-2077.123401

[39] Extradigital Glomus Tumour. Journal of Hand Surgery. 1995. DOI: 10.1016/s0266-7681(05)80105-6

[40] Glomus tumors of the wrist. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80095-1

[41] Subungual glomus tumors of the hand. Indian Journal of Orthopaedics. 2015. DOI: 10.4103/0019-5413.159611

[42] Malignant glomus tumor of the thumb: A case report. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80057-3

[43] Enormous glomus tumor of the shoulder. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90162-3

[44] A rare tumor at the elbow: a glomangioma. Archives of Orthopaedic and Trauma Surgery. 1989. DOI: 10.1007/bf00932451

[45] Glomus tumor originating within a digital nerve. The Journal of Hand Surgery. 1990. DOI: 10.1016/s0363-5023(09)91114-5

[46] Les tumeurs glomiques de la main: une étude rétrospective de 11 cas. Pan African Medical Journal. 2016. DOI: 10.11604/pamj.2016.24.262.8154

[47] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[50] Magnetic Resonance Imaging in the Diagnosis of Glomus Tumours of the Hand. Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsb.2005.06.009

[51] The Association Between Glomus Tumors and Neurofibromatosis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.025

[53] Glomus Tumors and Neurofibromatosis. Plastic and Reconstructive Surgery Global Open. 2014. DOI: 10.1097/gox.0000000000000144

[54] Glomus Tumors. The Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsa.2006.05.018

[57] Glomus tumor of the scapular region. Journal of Shoulder and Elbow Surgery. 2000. DOI: 10.1067/mse.2000.108961

[58] Comparing Ultrasound with Magnetic Resonance Imaging in the Evaluation of Subungual Glomus Tumors and Subungual Myxoid Cysts. Skin Appendage Disorders. 2023. DOI: 10.1159/000530397

[61] Magnetic resonance imaging of a glomus tumor of the fingertip. The Journal of Hand Surgery. 1990. DOI: 10.1016/0363-5023(90)90072-y

[64] Intravascular Glomus Tumor of the Forearm Causing Chronic Pain and Focal Tenderness. Case Reports in Orthopedics. 2014. DOI: 10.1155/2014/619490

[66] Ultrasonography of a Subungual Glomus Tumour. Journal of Hand Surgery. 1993. DOI: 10.1016/0266-7681(93)90235-8

[68] Preoperative Evaluation of a Subungual Glomus Tumor Case Using Multidetector Computed Tomography Angiography. Annals of Dermatology. 2015. DOI: 10.5021/ad.2015.27.2.226

[69] Factors affecting surgical outcomes of digital glomus tumour: a multicentre study. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418774176

[70] Subungual Glomus Tumor With Nail Plate Defect in a 6‐Year‐Old Child: A Case Report and Literature Review. Clinical Case Reports. 2026. DOI: 10.1002/ccr3.72907

[71] Glomus tumors of the upper limb: Single-center retrospective study of clinical and functional outcomes. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2017.04.002

[72] Glomus tumors associated with the bone and joints: a review of 91 cases. Annals of Translational Medicine. 2020. DOI: 10.21037/atm-20-6998

[73] An Unusual Case of Multiple Recurrence of a Glomangioma. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1998.0013

[92] Characteristics of Glomus Tumors in the Hand Missed on MRI. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.096

[93] Glomus tumor of the fingertips. Journal of Family Medicine and Primary Care. 2019. DOI: 10.4103/jfmpc.jfmpc_88_19

[96] A propos d’une observation de tumeur glomique de l’index. Pan African Medical Journal. 2017. DOI: 10.11604/pamj.2017.26.155.11899

[97] Intravenous Glomus Tumor Masquerading as Lateral Antebrachial Cutaneous Neuroma. HAND. 2016. DOI: 10.1177/1558944716675296

[98] Glomus Tumor of Digital Nerve: Case Report. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.035

[99] A microscopic transungual surgical approach for subungual glomus tumor resection. Frontiers in Medicine. 2025. DOI: 10.3389/fmed.2025.1607299

[106] The clinicopathologic and immunohistochemical features of 60 cutaneous glomus tumor: a retrospective case series study. Anais Brasileiros de Dermatologia. 2024. DOI: 10.1016/j.abd.2023.03.005

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.