Clinical Examples: Pyogenic Granuloma

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.
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Case 1
Pyogenic granuloma with bandage maceration.
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Case 2
Pedunculated shape is common as the mass grows larger than the skin defect.
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Case 3
Pyogenic granuloma arising on the side of the index finger.
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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:
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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.
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Case 5
Prominent fingertip pyogenic granuloma.
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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.
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Case 6
Index finger involvement.
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Case 7
Similar location as mucous cyst.
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After curettage (finger tourniquet still in place).
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Case 8
Dark, hardened appearance from repeated bleeding episodes in this anticoagulated patient.
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Case 9
Unusual location on the back of the hand.
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