Clinical Examples: Pyogenic Granuloma
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Pyogenic granuloma is a benign vascular tumor arising in
the skin or mucous membranes. In the hand, it presents
as a rapidly growing friable painless tumor which bleeds
easily. It is usually attached by a stalk having a
smaller diameter than the visible mass. Treatment is
curettage and then optionally cautery of the base with
silver nitrate. Although reported to have a high
recurrence rate in the hand, I believe that this
reflects inadequate debridement because of the thickness
of surrounding callus which is produced in hand lesions
and the use of cautery without adequate curettage. They
may develop following minor trauma, and I suspect that
in the hand, these are related to intradermal foreign
body reaction, although I have no proof of this. Each of the cases below were treated in the office with curettage under local anesthesia. |
| Click on each image for a larger picture |
| Case 1 Pyogenic granuloma with bandage maceration. |
| Case 2 Pedunculated shape is common as the mass grows larger than the skin defect. |
| Case 3 Pyogenic granuloma arising on the side of the index finger. |
| Curative treatment with curettage and cautery in the office under local anesthesia with tourniquet control. The stalk was half the diameter of the lesion and the surrounding skin is white from was maceration from continuous contact with the moist surface of the tumor: |
| Case 4 Another patient, on coumadin, with recurrent bleeding from a pyogenic granuloma. The typical mushroom shape can be seen. Curettage and silver nitrate cautery were curative. |
| Case 5 Prominent fingertip pyogenic granuloma. |
| Removal in office
under digital block. The skin defect at the neck of
the tumor is usually much smaller than the mass.
Curettage should extend through the skin and the base
may then be cauterized, but this is optional. |
| Case 6 Index finger involvement. |
| Case 7 Similar location as mucous cyst. |
| After curettage
(finger tourniquet still in place). |
| Case 8 Dark, hardened appearance from repeated bleeding episodes in this anticoagulated patient. |
| Case 9 Unusual location on the back of the hand. |
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