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A 20-year-old woman, who was being seen by her family physician for her prenatal care, presents to the office with a new growth on her lip. She stated that the growth on her lip bled very easily but was not painful. She was diagnosed with a pyogenic granuloma (PG) and preferred to wait until her pregnancy was over to have it removed. The lesion did not regress spontaneously after pregnancy and was surgically excised.

PG is the name for a common, benign, acquired, vascular neoplasm of the skin and mucous membranes.

The term lobular capillary hemangioma has been suggested because PG is neither pyogenic (purulent bacterial infection) nor a granuloma.1

  • Most often seen in children and young adults (0.5% of children's skin lesions); 42% of cases occur by 5 years of age and approximately 1% are present at birth.1
  • Oral lesions occur most often in the second and third decade, more commonly in women (female-to-male ratio is 2:1).1
  • Also common during pregnancy.
  • PG has also been reported in the GI tract, the larynx, and on the nasal mucosa, conjunctiva, and cornea.

  • Etiology is unknown but may be the result of trauma, infection, or preceding dermatoses.
  • Consists of dense proliferation of capillaries and fibroblastic stroma that is infiltrated with polymorphonuclear leukocytes.
  • Multiple PGs have been reported at burn sites and following use of oral contraceptives, protease inhibitors, and topical application of tretinoin for acne.2
  • PGs are known to regress following pregnancy. Vascular endothelial growth factor (VEGF) was found in one study to be high in the granulomas during pregnancy, was almost undetectable after parturition, and was associated with apoptosis of endothelial cells and regression of granuloma.3

  • Trauma (up to 50%) or chronic irritation.1
  • Multiple lesions can follow manipulation of a primary lesion.4
  • Pregnancy or use of oral contraceptives for oral PGs; postulated caused by imbalance between angiogenesis enhancers and inhibitors.1
  • Infection with Bartonella.1

Clinical Features

  • Usually solitary, erythematous, dome-shaped papule or nodule that bleeds easily (Figures 161-1, 161-2, 161-3, 161-4, 161-5, 161-6, 161-7, and 161-8); rarely causes anemia. Satellite lesions may rarely occur.
  • Prone to ulceration, erosion, and crusting.
  • Size ranges from a few millimeters to several centimeters (average size is 6.5 mm).1
  • Rapid growth over a period of weeks to maximum size.
  • Variants include cutaneous, oral mucosal (granuloma gravidarum), satellite, subcutaneous, intravenous, and congenital types.1

Figure 161-1

Pyogenic granuloma on the lower lip arising during pregnancy. (With permission from Usatine RP, Moy RL, Tobinick EL, ­Siegel DM. Skin Surgery: A Practical Guide. St. Louis, MO: Mosby; 1998.)

Figure 161-2

Pyogenic granuloma on the nose in ...

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