A 53-year-old Man With Pyogenic Granuloma

Gary Goldenberg, MD


March 10, 2010

Clinical Presentation


A 53-year-old man


The patient presented for evaluation of a growth on his left thumb. This growth has been present for several months and had been previously treated with surgical excision at another office. The lesion originally grew rapidly and recurred within 3 weeks of original excision. The patient reported exquisite tenderness to touch and spontaneous bleeding. He denied starting any new medications, and there was no history of trauma to the area.


Physical examination revealed a polypoid, ulcerated, erythematous, crusted nodule with exuberant granulation tissue on the left thumb that measured 1.4 cm by 1.3 cm (Figure 1). Palpation induced bleeding and elicited tenderness. No satellite lesions or signs of infection were noted.

Figure 1. Erythematous, ulcerated, well-defined plaque and evidence of bleeding.

Laboratory Findings

A bacterial culture was performed and showed no growth. A biopsy was then performed (Figure 2).

Figure 2. Small vascular channels and erythrocyte extravasation.

The biopsy showed a polypoid papule with superficial epidermal erosion and crusting. The epidermis was thinned centrally and formed a collarette around a dermal vascular proliferation. The dermis showed small capillaries engorged with erythrocytes and arranged in lobules and mixed inflammation with lymphocytes, histiocytes. and neutrophils.