Derm Dx: A Bleeding Mole on the Forehead

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is an acquired benign vascular tumor of the skin or mucous membrane.1  PG is considered a misnomer as it does not represent the accurate clinical (not pyogenic) or histologic (no granulomatous...

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Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is an acquired benign vascular tumor of the skin or mucous membrane.¹  PG is considered a misnomer as it does not represent the accurate clinical (not pyogenic) or histologic (no granulomatous inflammation) findings.² Although PG can occur in any patient, it is more common in children, young adults, and women of childbearing age.³

The benign vascular tumor often presents at the site of a recent injury.³ When PG occurs on the oral mucosal surface, often in women during their second or third trimester of pregnancy, the tumor can be referred to as the “pregnancy tumor” or “granuloma gravidarum.”² PG can result from use of certain medications such as isotretinoin, chemotherapeutic drugs, and protease inhibitors; it may also occur in patients undergoing laser treatment for port-wine stains.²

PG most commonly affects the hands, lower lips, and gingival regions.⁴ The clinical presentation of the lesion is a glistening, friable, bright red papule with possible central ulceration or crusting.² The base of the lesion is well circumscribed beneath any overlying scale.² The lesion has a tendency to bleed profusely; this prominent symptom commonly distinguishes PG from other diagnoses.⁴

PG is a benign disorder; most individuals seek treatment because of recurrent bleeding episodes. The treatment plan should consider lesion size and location as well as patient aesthetic concern. Surgical excision has an extremely low recurrence rate but a higher rate of scarring compared with curettage or shave excision with cautery, which have a higher recurrence rate but less chance of scarring.⁵ Additional treatment options include cryotherapy, CO₂ laser, and sclerotherapy.

Lauren Ax, PA-S, is a student at Arcadia University, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Koo M, Lee S, Han S. Pyogenic granuloma: a retrospective analysis of cases treated over a 10-year. Arch Craniofac Surg. 2017;18(1):16-20. 
2. Craft N, Fox LP. Visual Dx: Essential Adult Dermatology. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:130.
3. LeBoit P, Burg G, Weedon D, Sarassain A.  Pathology and Genetics of Skin Tumours. Lyon, France: International Agency for Research on Cancer; 2006:243.
4. Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G Pyogenic granuloma – a common benign vascular tumor with variable clinical presentation: new findings and treatment options. Open Access Maced J Med Sci. 2017;5(4):423-426.
5. Gilmore A1, Kelsberg G, Safranek S.  Clinical inquiries. What’s the best treatment for pyogenic granuloma? J Fam Pract. 2010;59(1):40-42.