Pyogenic granuloma
Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor of the skin or mucous membranes that grows rapidly over weeks to months into a friable, easily bleeding papule or nodule, most often on the trunk or extremities in children and young adults. Because it rarely regresses spontaneously and can mimic malignant lesions, full-thickness surgical excision that yields tissue for histopathology is the preferred treatment for most lesions in noncosmetically sensitive areas.
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What this article covers
- Overview
Rapidly growing, friable vascular tumor: pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor of the skin or mucous membranes with rapid growth and a friable surface.
- Epidemiology
Peak in the second and third decades of life: occurs at any age, with a peak incidence in the second and third decades.
- Risk factors
Local trauma: acute mechanical trauma, chronic nail manipulation, or onycholysis is reported in a minority of cases overall but in 58 percent of periungual or subungual disease.
- Pathophysiology
Hyperplastic neovascular response of unclear cause: despite the name, pyogenic granuloma is not infectious; most theories describe a hyperplastic response to an angiogenic stimulus with imbalanced promoters and inhibitors.
- Clinical features
Defining pattern: a small, red papule that grows rapidly over weeks to months and then stabilizes, rarely exceeding one centimeter, pedunculated or sessile, with a characteristic collarette of acanthotic epidermis at the base.
- Differential diagnosis
Infantile hemangioma: bright red papules, nodules, or plaques in early infancy that grow rapidly but rarely bleed, unlike pyogenic granuloma, and involute rather than persist; immunohistochemistry is…
- Diagnosis
Clinical pearl. A solitary, rapidly growing, dome-shaped papule that bleeds easily after minor trauma over days to weeks is characteristic of pyogenic granuloma, but because amelanotic melanoma and…
- Management
First step for lesions in noncosmetically sensitive areas, full-thickness surgical excision: perform narrow elliptical excision of the skin beneath the lesion to the subcutaneous fat with suture…
- Complications
Profuse or recurrent bleeding: bleeding after minor trauma is often difficult to control and recurrent, the most common reason lesions are treated.
- Prognosis
Low likelihood of spontaneous regression: in clinical experience, lesions generally do not spontaneously involute, though regression over 6 to 18 months has been reported in a few patients.
- Prevention
Prompt removal or avoidance of provoking factors: identifying and removing or discontinuing a provoking factor such as trauma, a foreign body, or a causative medication when feasible reduces the risk of new or recurrent lesions.
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