Pyogenic granuloma (PG) can be regarded as a benign vascular tumor or as a reactive vascular process arising at sites of previous trauma or irritation. PG is also known as lobular capillary hemangioma, granuloma telangiectaticum, and granuloma gravidarum when presenting on the gingiva of pregnant women. It commonly occurs in areas of trauma including the face and fingers.
Age: most common in children and young adults
Precipitating factors: minor trauma, pregnancy, laser treatment of port-wine stains, isotretinoin
Reactive neovascularization suggested by common association with preexisting trauma or irritation and limited growth capacity.
Red to violaceous, dome-shaped, friable papule or nodule, 0.5 to 1.5 cm in size, with smooth surface that frequently ulcerates (Figs. 35.1, 35.2 and 35.3).
Classic hemorrhagic pyogenic granuloma
Pyogenic granuloma on the palm of a pregnant woman, bleeding frequently
Pyogenic granuloma overlying a dermal nevus
Nodular amelanotic melanoma, glomus tumor, hemangioma, squamous cell carcinoma (SCC) (Fig. 35.4), nodular basal cell carcinoma, wart, bacillary angiomatosis, Kaposi’s sarcoma, and metastatic cancer.
Pyogenic granuloma mimicking a squamous cell carcinoma on the left lower mucosal lip of a patient with multiple nonmelanoma skin cancers
Well-circumscribed exophytic lobular proliferation of capillaries with flattened and sometimes eroded overlying epidermis with peripheral epidermal “collarettes.”
PG usually grows rapidly over the course of weeks or months and then stabilizes. It bleeds frequently with minor trauma and can persist indefinitely if not treated.
– Pulsed dye laser (585–600 nm, 0.45–1.5 ms, 7–10 mm, 6–15 J/cm2, DCD 20–40/20 with or without diascopy) is a safe and effective device for the treatment of small lesions and for pediatric patients. Serial treatments are usually required. Treatment is well tolerated without anesthesia. A recent report suggested shave excision followed by immediate pulse dye laser (PDL) for larger lesions. PDL has been also reported to be effective in gingival PG. Nd:YAG laser can also be effective.
– Carbon dioxide is effective. Lesional flattening is the clinical endpoint. Intralesional lidocaine 1% is necessary prior to treatment. Postoperative care requires twice daily cleansing with soap and water and application of antibiotic ointment over a 2 to 6 weeks healing time. Scar formation ...