The majority of imaged leiomyomas are associated with the smooth muscle of the female reproductive organs (uterus, cervix and broad ligament) and so have a female predominance. They are commonly known as fibroids. However, leiomyomas can be found where smooth muscle is present, such as the urinary bladder, prostate, esophagus, stomach, colon and trachea. There is also smooth muscle cells in the skin, which is where this case would have arisen. Cutaneous leiomyomas are often multiple small skin lesions that do not need imaging. This case has a long history (20 years) and so that has given time for degeneration and calcification, which is commonly seen in fibroids.