What causes pyogenic granuloma?

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Question asked by David Howard, Shenyang, China

I'm an American living in China. Two months ago I had a pyogenic granuloma surgically removed from the palm of my hand. It had grown to about 2 x 3 centimeters in size and would often bleed. Now I have several (eight) small granulomas starting in the same general, but larger area. Could there be an alternative diagnosis or cause?

Expert answer

Pyogenic granuloma is a skin lesion also called granuloma telangiectaticum. It is not an infection as the name suggests. The lesion is caused by growth of small blood vessels. It can be several centimeters (up to one inch in diameter). They can be found anywhere on the skin or even on the gums of the mouth. The cause of these lesions is unknown. They often, but not always, occur after some type of trauma. They also commonly occur during the early stages of pregnancy and can regress after pregnancy.

The diagnosis is suspected when there is a history of a reddish and flesh colored dome shaped lesion that developed over the course of a few days to three weeks and bleeds easily. It can be confused with other lesions such as a type of melanoma known as amelanotic melanoma. This skin cancer without pigment usually develops more slowly. There are many noncancerous lesions that can be confused with a pyogenic granuloma. Among them are benign nevi or moles and a lesion called dermatofibrosis. Biopsy and microscopic evaluation of the lesion is often needed to be sure.

A definite pyogenic granuloma need not be treated unless it is bothersome. Common reasons for treatment are cosmetic inconveniences and some bleed easily with minor trauma. Treatment is a minor surgical excision. There are several methods of surgical removal. A method known as a "punch biopsy" is preferred, but can be difficult in certain areas of the body especially certain areas of the hand. A shave excision or shaving with electrocautery - using an electrified probe - to stop bleeding are two methods used when punch biopsy cannot be done. The punch biopsy removes some deeper tissue and is more likely to get the entire lesion. These lesions do recur after an inadequate surgery, but they can also recur after an adequate surgery.

The multiple lesions that you describe after surgery are consistent with what is referred to as "satellite lesions" which sometimes do occur after an excision of a single pyogenic granuloma. These satellite lesions are best evaluated and treated by a dermatologist experienced in their removal and you may need referral to a plastic surgeon who specializes in hand surgery.