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pyogenic granuloma ;granuloma telangiectaticum; lobular capillary hemangioma
A rapidly developing hemangioma occasionally occurring at sites of minor trauma.
Etiology:
- minor trauma
- medications, such as indinavir [5]
Epidemiology:
1) children & adults < 30 years old
2) no sex predilection
Pathology:
1) proliferation of capillaries
2) prominent endothelial cells within edematous, gelatinous stroma
3) epidermis is commonly eroded
4) dense infiltrate of neutrophils is common
* histopathology image [6]
Clinical manifestations:
1) solitary erodied vascular nodule that bleeds spontaneously or following minor trauma
2) bright red, dusky red, violaceous or brown-black nodule with smooth surface < 1.5 cm in diameter
3) dome-shaped, sessile or pedunculated
4) occurs as solitary lesion on finger, lip, mouth, trunk or toe
5) may be epidermal collarette at base on palm or sole
5) lesions may persist for months
* images [3,4,6]
Laboratory:
- biopsy with histological examination
Differential diagnosis:
1) nodular malignant melanoma (may be amelanotic) [6]
2) squamous cell carcinoma
3) glomus tumor
4) nodular basal cell carcinoma
5) metastatic carcinoma
6) bacillary angiomatosis
Management:
1) biopsy with histological examination
2) surgical excision (recurrence uncommon)
3) curettage of scissor excision (for histopathology) followed by electrodessication or pulse dye laser (lesions may recur)
General
nevus
cutaneous hemangioma
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 160-61
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Pierson JC, James WD (images)
Dermatologic Manifestations of Pyogenic Granuloma (Lobular
Capillary Hemangioma).
http://emedicine.medscape.com/article/1084701-overview
- DermNet NZ. Pyogenic granuloma (images)
http://www.dermnetnz.org/vascular/pyogenic-granuloma.html
- NEJM Knowledge+ Question of the Week. Aug 22, 2017
https://knowledgeplus.nejm.org/question-of-week/1424/
- Lipner SR
Ulcerated Nodule of the Fingernail.
JAMA. Published online February 16, 2018.
PMID: 29453865
https://jamanetwork.com/journals/jama/fullarticle/2672333