Pyogenic Granuloma on Thumb

Diagnosis: Pyogenic Granuloma on Thumb

Pyogenic Granuloma on Thumb

Clinical Presentation

Pyogenic Granuloma on Thumb

Clinical History

Rapidly growing, friable, red papule that bleeds easily. Pregnancy, medications (retinoids, EGFR inhibitors). Common sites: fingers, lips, gingiva.

Treatment

Shave excision with curettage and electrocautery of base. Silver nitrate cautery. Cryotherapy. Always submit for histopathology. Pulsed dye laser. Topical timolol for small lesions.

Differential Diagnosis

• Amelanotic melanoma • Squamous cell carcinoma • Kaposi sarcoma • Bacillary angiomatosis • Hemangioma • Glomus tumor • Angiosarcoma

Key Learnings

• Misnomer — neither pyogenic nor a granuloma; it is a lobular capillary hemangioma • Rapidly growing, friable, red papule that bleeds easily with minor trauma • Common in children and pregnant women ("pregnancy tumor" / granuloma gravidarum) • Medications: oral retinoids, EGFR inhibitors, antiretrovirals can cause them • Histology: lobular arrangement of capillaries with edematous stroma • Always send for histology to exclude amelanotic melanoma • Recurrence rate ~40% after incomplete removal — satellite lesions can develop

Tags: dermatologist, dermatology, kodachrome, Pyogenic Granuloma on Thumb