PYOGENIC GRANULOMA: a case study Carson Higgs, MD and Sally P. Weaver, PhD, MD McLennan County Medical Education and Research Foundation, Family Medicine Residency Program, Waco, Texas HISTORY DISCUSSION DIFFERENTIAL DIAGNOSIS S.S is a 7 year old African American female who presents with a lesion on her thumb that began approximately 3-4 weeks ago as a “blood blister”. Patient initially presented to both local EDs and was referred to her PCP for diagnosis/treatment. The lesion has been frequently picked at, per mom, and has grown to its current size. Past Medical History Atopic dermatitis She is a thumb sucker. PYOGENIC GRANULOMA (granuloma telangiectaticum) --Diagnosed by clinical history - Erythematous, friable, dome-shaped papule that develops over days to weeks - Associated with capillary proliferation, not bacterial infection - often occur after a history of antecedent trauma - In children, most commonly located on an extremity AMELANOTIC MELANOMA - rapidly growing nodule SPITZ NEVI - in children ANGIOSARCOMA in the elderly, especially if on the head and neck occurs in the setting of chronic lymphedema & after radiation therapy BACILLARY ANGIOMATOSIS - in patients with HIV Treatment is indicated if: - patient desires removal for cosmetic reasons - location is bothersome - lesion bleeds easily with minor trauma EXAM AND PROCEDURE EXAM: normal exam, except for 20 mm friable granuloma on lateral, distal surface of left thumb --Excision usually performed by punch excision, shave excision and/or electrodessication and curettage --Histologic confirmation should be performed if suspicion of amelanotic melanoma or unsure of diagnosis based on history. PROCEDURE: - Left thumb was anesthetized with digital block using 1 % lidocaine without epinephrine. Hemostasis with donut applied to thumb - Lesion was shaved and ablated to level flush with surrounding normal epidermis using the Ellman Surgitron small loop electrode and vascular bed cauterized with the ball electrode Examples of pyogenic granulomas at other body sites: BIBLIOGRAPHY Goldstein, Beth G. "Benign Neoplasms of the Skin." UpToDate. http://www.uptodate.com. - "Dermatology Glossary." http://missinglink.ucsf.edu. - “Merck Medicus.” http://www.merckmedicus.com - "Pyogenic Granuloma." http://emedicine.com - "Angiosarcoma." http://liddyshriversarcomainitiative.org. - "Pyogenic Granuloma." http://medscape.com. - "Pyogenic Granuloma." www.nature.com.