Photo Rounds

Bleeding lesion on nose

A 58-year-old woman went to her family physician (FP) with a growth at the corner of her nose that she’d had for 6 months. The patient originally thought the growth was a pimple and admitted to squeezing it, but became worried and stopped squeezing when it started bleeding spontaneously or with simple manipulation. She denied any history of other skin problems, although she did mention that her mother had a few basal cell carcinomas in the previous 5 years.

After injecting lidocaine with epinephrine, the FP waited 10 minutes and then performed a shave biopsy. There was significant bleeding, so pressure was applied and electrocoagulation was performed successfully.

What is your diagnosis?


One week later, the pathologist reported that the growth was an amelanotic melanoma of 1.2 mm depth. The FP was relieved that he sent the tissue for pathology and did not assume this was a benign pyogenic granuloma. The patient was referred to a head and neck surgeon for complete excision with margins and a sentinel lymph node biopsy. She was fortunate to not have any nodal metastases. The FP performed a complete skin exam and found no other lesions suspicious for melanoma.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Usatine R. Pyogenic Granuloma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine . 2nd ed. New York, NY: McGraw-Hill; 2013: 940-944.

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