Procedures

Lesions that do not respond appropriately to conservative treatment should undergo biopsy to confirm the diagnosis.

Histologic Findings

Proliferation of capillaries is present, with prominent endothelial cells embedded in edematous gelatinous stroma in a characteristic lobular configuration (see image below).

Histologic image showing epidermal erosion and crusting, thinned epidermis, vascular proliferation, and mixed inflammation with lymphocytes, histiocytes, and neutrophils. Courtesy of Medscape Dermatology.

View Media Gallery

The epidermis is commonly eroded.

A dense infiltrate and granulation tissue with polymorphonuclear leukocytes may be present.

Hyperproliferation of the epidermis is usually present at the margins of the vascular growth, which results in a collarette of epidermis.^{[16, 29, 30]}

Treatment & Management

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Media Gallery

Pyogenic granulomas are usually solitary lesions. The fingers and hands are common locations for these to develop. A history of minor trauma at the site shortly before development of the lesion is frequent.
Pyogenic granulomas usually bleed with little or no trauma. This patient shows a positive bandage sign. Because the lesions bleed so easily, patients frequently present with a bandage covering the site.
Pyogenic granulomas usually have a distinct margin that consists of a rim of keratin (dry skin). Notice the moist area of skin produced by the bandage, which was removed shortly before the photograph was taken.
Pyogenic granulomas may be pedunculated and quite large. An area of necrosis is also common.
Pyogenic granulomas may occur at various sites. More than 60% of all lesions develop on the head and neck.
Unlike pyogenic granulomas, cherry angiomas such as these are slow to develop, do not bleed easily, are frequently multiple, are more commonly found on the trunk, and seldom have a history of prior trauma.
Several malignant tumors may mimic pyogenic granulomas. This lesion is a squamous cell carcinoma. Amelanotic melanomas (little or no overt pigment) are also included in the differential diagnosis. These tumors are usually slower growing than pyogenic granulomas and are uncommon in children. Tissue removed as part of the treatment process should be sent for histopathologic examination to confirm the diagnosis.
Small pyogenic granuloma.
Histologic image showing epidermal erosion and crusting, thinned epidermis, vascular proliferation, and mixed inflammation with lymphocytes, histiocytes, and neutrophils. Courtesy of Medscape Dermatology.

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Author

Brian Keene, DO Staff Physician, Department of Family Medicine, Tripler Army Medical Center

Brian Keene, DO is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Clark H Cobb, III, MD Assistant Professor of Family Medicine, Uniformed Services University of Health Sciences; Assistant Clinical Professor of Family Medicine, Philadelphia College of Osteopathic Medicine, Georgia Campus; Affiliate Faculty, Family Medicine Residency Program, Columbus Regional Medical Center; Lecturer, Hughston Sports Medicine Clinic

Clark H Cobb, III, MD is a member of the following medical societies: American Academy of Family Physicians, Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Yevgeniy Zenchenko, MD Resident Physician, Department of Family Medicine, Tripler Army Medical Center

Yevgeniy Zenchenko, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

Brett Steinberg, DO Primary Care/Internal Medicine, Staff Physician, US Army Medical Activity, Bavaria

Brett Steinberg, DO is a member of the following medical societies: American Osteopathic Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.