Derm Dx: A red, rapidly growing bump on the tongue

Pyogenic granuloma is a relatively common nonmalignant vascular neoplasm. The term pyogenic granuloma is a misnomer since it is neither infectious (pyogenic) nor granulomatous. A preferred synonym is lobular capillary hemangioma, which also describes the lesion's histopathological features.  Pyogenic granulomas...

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Pyogenic granuloma is a relatively common nonmalignant vascular neoplasm. The term pyogenic granuloma is a misnomer since it is neither infectious (pyogenic) nor granulomatous. A preferred synonym is lobular capillary hemangioma, which also describes the lesion’s histopathological features. 

Pyogenic granulomas may present at any age but are more common in children. Men and women are equally affected, with the exception of gingival lesions, which are seen with greater frequency in pregnant women.

A pyogenic granuloma begins as a small red papule, which rapidly grows into a friable red polyp. Once it reaches its peak size, the lesion stabilizes. In most cases it will not spontaneous regress, but rather persists indefinitely unless treated. 

Pyogenic granulomas frequently bleed and may become frankly ulcerated. The most common sites are the gingiva, fingers, lips, face and tongue. The lesions may develop after minor trauma, and some cases are associated with medications, especially systemic retinoids, indinavir, capecitabine and anti- epidermal growth factor receptor therapies such as cetuximab. 

When biopsied, the histopathology demonstrates an exophytic and well-circumscribed, lobular proliferation of small capillaries.  

Pyogenic granulomas are most commonly treated with shave excision or curettage. The lesion will recur if only shaved superficially. Therefore, the base of the lesion needs to be destroyed, either with silver nitrate or electrodesiccation. Excision with suturing is also effective. Small lesions may respond to pulse dye laser.

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.