CV

Pyogenic Granuloma

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Pyogenic Granuloma, Epulis Gravidarum, Lobular Capillary Hemangioma

  • Definition
  1. Highly vascular variant of Capillary Hemangioma
  • Epidemiology
  1. Common lesion in children and young adults
  • Causes
  1. Often idiopathic
  2. Prior Trauma (esp. penetrating injury) or Burn Injury
  3. Viral Infection
  • Symptoms
  1. Bleeding from friable lesion
    1. Occurs with minimal Trauma
  • Signs
  1. Characteristics
    1. Initial
      1. Small bright red, purple to yellow dome-shaped Papule
      2. Grows rapidly into Nodule
      3. Moist, glistening surface
      4. Often pedunculated, pulpy vascular lesions
      5. Surrounded by Scaling collarette
    2. Later
      1. Fibrous lesion similar to fibroma
  2. Distribution
    1. Head and neck
    2. Eyelid (most common acquired Eyelid lesion)
    3. Extremities
      1. Finger tips
      2. Lateral nailfold (periungual)
    4. Gingiva or other mucosal surface
      1. Occurs in infants, children and young adults
      2. Pregnant women (Epulis gravidarum)
        1. Onset in 2% of women in late first trimester, second trimester and resolves with delivery
  • Differential Diagnosis
  1. Nodular Melanoma
    1. Elmets (1980) Cutis 25:164-8 [PubMed]
  2. Spitz Nevus
  3. Amelanocytic Nevus
  4. Squamous Cell Skin Cancer
  5. Basal Cell Skin Cancer
  • Management
  1. Shave excision with electrodesiccation and curretage (or laser ablation)
  2. Send lesion for pathology due to differential diagnosis
  3. Recurs if not completely excised
  • References
  1. Habif (1996) Dermatology, Mosby-Year, p. 732
  2. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
  3. Luba (2003) Am Fam Physician 67(4):729-38 [PubMed]