Pyogenic Granuloma

Author:
Joe R. Monroe, MPAS, PA
Dermatology Associates of Oklahoma, Tulsa

Citation:
Monroe JR. Pyogenic granuloma. Consultant. 2017;57(6):382.

A 40-year-old woman presented with a 3-month history of a nonhealing, friable nodule on the palm of her right hand. The lesion was tender to the touch, but more concerning for the patient, it bled profusely with minimal trauma, such as when she would reach into her purse or pocket.

The lesion on her hand had started with a small puncture wound, which produced a scab that she had found difficult to leave alone, and she picked at it daily. As the lesion grew slowly, she picked at it all the more. The patient’s health was good in all other respects.

Physical examination. Examination showed a bright red, shiny, 5-mm papule on the palm of the metacarpophalangeal joint, sitting up prominently and surrounded by an epidermal collarette. There was no associated erythema to speak of around the lesion.

Diagnostic tests. Under local anesthesia, the lesion was shaved off and the base electrodesiccated and curetted; the bleeding was controlled, and a specimen was submitted for pathology testing.

The pathology report confirmed the suspected diagnosis of pyogenic granuloma (PG), also known as a lobular capillary hemangioma.

PG is a completely benign lesion that usually arises from repeated trauma but can be seen in conjunction with ingrown toenails or with the use of certain medications such as isotretinoin or indinavir. PGs are particularly common on the fingers, nipples, and faces of children.

Although not invariably present, the epidermal collarette seen in this patient’s case is quite typical for PG lesions, especially those seen on the hand.

Since nodular melanoma can present in this fashion, PG specimens are always sent for pathologic examination after removal. Occasionally, PG lesions are small enough that treatment with topical applications of silver nitrate or liquid nitrogen can eliminate them. Superficial removal by shave inevitably leads to recurrence.