Pyogenic Granuloma (periungual)

Diagnosis: Pyogenic Granuloma (periungual)

Bright red, friable nodule on periungual skin.

Clinical Presentation

Bright red, friable nodule on periungual skin.

Clinical History

Submitted by Alaa Saad. Originally posted November 5, 2010.

Treatment

See case discussion.

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: pyogenic, granuloma, periungual, alaa saad