AKT · Dermatology/Benign lesions

Pyogenic granuloma

Benign reactive vascular proliferation (lobular capillary haemangioma)

Overview

A common benign reactive overgrowth of capillaries (lobular capillary haemangioma) — neither pyogenic nor a granuloma. A rapidly growing, friable, bright-red nodule that BLEEDS profusely with minor trauma, often after a minor injury, in pregnancy, or on the fingers/lips. (One of the lesions Raahat met in the exam.)

Recognise

Rapidly growing (over days–weeks), bright-red, friable, often pedunculated nodule that bleeds easily and profusely
Common on fingers, lips and gingiva; associated with minor trauma and pregnancy ("epulis" of pregnancy on the gums)
A collarette of scale may surround the base

Red flags

Bleeding can be troublesome; an amelanotic melanoma or nodular SCC can mimic a "pyogenic granuloma" — histology after removal is important

Differentials & how to tell them apart

Amelanotic melanomathe critical mimic — a non-pigmented melanoma can look identical, hence always send histology

Nodular/SCCkeratotic, sun-damaged skin — biopsy

Infantile haemangiomainfant, proliferation-involution course, not the acute friable bleeding nodule

Bacillary angiomatosisimmunosuppressed/HIV, Bartonella — vascular papules

Clinical image

We can't host this one — the image is DermNet's and their licence doesn't cover us republishing it. Their page for it is free to view.

Pyogenic granuloma — clinical imagesDermNet

Investigations

Clinical; send the excised/curetted specimen for HISTOLOGY (to exclude amelanotic melanoma and other mimics).

Management

Curettage and cautery (or excision) with histology

1Remove by curettage and cautery (or excision) and SEND FOR HISTOLOGY.Gate: Always send a "pyogenic granuloma" for histology — an amelanotic melanoma or nodular SCC can be clinically indistinguishable, so do not just destroy it without a tissue diagnosis
2Recurrence is not uncommon (especially satellite lesions) → re-excise; pregnancy-associated lesions may be observed as they can regress post-partum.

Curettage + cautery, or excision — first-line — removes the lesion and provides histology

Topical/observation in pregnancy — pregnancy-associated lesions may regress after delivery

Key points

Misleadingly named — it is a vascular lesion. The exam pearls: it bleeds dramatically with minor trauma, and you must exclude amelanotic melanoma on histology.

Monitor & prognosis

Recurrence; histology result.

Benign; may recur after removal.

Source: DermNet; StatPearls