Photo Rounds

Growth on finger

A 22-year-old woman presented to her family physician (FP) because she was concerned about a growth on her index finger. The patient said the growth first appeared about 2 months earlier and every time she traumatized it, there was much bleeding. She was in otherwise good health.

What’s your diagnosis?


 

The FP diagnosed pyogenic granuloma (PG), a common, benign, acquired vascular lesion of the skin and mucous membranes. PGs are erythematous, dome-shaped papules or nodules that bleed easily. They are prone to ulceration, erosion, and crusting, and rapid growth may occur over a period of weeks. The etiology for PG is unknown, but may be the result of trauma, infection, or preceding dermatoses. A more up-to-date and appropriate term for PG is lobular capillary hemangioma, because these lesions are neither pyogenic nor granulomas.

PGs are most often found on the fingers, lips, and hands. They may resemble a number of malignancies including basal cell carcinoma, Kaposi’s sarcoma, metastatic cutaneous lesions, squamous cell carcinoma, and amelanotic melanoma. For that reason, it’s especially important to send the excised lesion for pathology to ensure that malignancy isn’t missed.

The patient was eager to have the PG removed at this visit, as a number of previous visits to urgent care centers resulted in courses of antibiotics that didn’t help. After performing a digital block, the FP removed the PG with a shave excision, followed by electrodesiccation and curettage. The electrodesiccation and curettage are important to prevent recurrence. In this case, the pathology confirmed the diagnosis, and the PG did not recur.

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.

To learn more about the Color Atlas of Family Medicine , see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

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