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June 2002
Case submitted by Stephen M. Schleicher,
MD, and Lawrence A. Schiffman, DO
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CASE:
A 37-year-old beautician has a growth on her right thumb
that developed about two weeks prior to seeking medical consultation.
She cannot recall specific trauma to the site, which sometimes
bleeds profusely. Examination reveals a 0.6 cm by 0.6 cm bright
red, friable mass emanating from the proximal nail fold. Palpation
elicits minimal tenderness. Under local anesthesia, the lesion
is removed with a curette and the base is electrodessicated.
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| What is your diagnosis? |
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Pyogenic granuloma is a rapidly developing vascular
lesion that at times may occur at the site of minor trauma.
The solitary lesion first presents as a tiny red or bluish-black
papule that quickly enlarges and may attain a size of 1.5 cm.
Most common in children, pyogenic granuloma also has a predilection
for developing in pregnant women. Recurrent bleeding episodes,
along with the cosmetic disfigurement, usually prompt medical
attention. Diagnosis is based on clinical appearance, although
some lesions may resemble amelanotic melanoma and histopathologic
confirmation is indeed prudent. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Schiffman is a fellow at the DermDx Centers for Dermatology.
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