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September 15th, 2010
08:35 AM ET

What causes pyogenic granuloma?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the
American Cancer Society.

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.


soundoff (62 Responses)
  1. AmishAirline

    I had one of these near my fingernail once. It was horrible-looking. Looked like a rat nipple. Just wanted to share. Carry on.

    September 15, 2010 at 13:29 | Report abuse | Reply
  2. Another Doc

    Dr Brawler's response is correct but incomplete. If you have a lesion of your skin and it looks like a PG it must be surgically removed in order to get a definitive diagnosis. If you just leave it there and don't get a tissue diagnosis you may be neglecting (and your Doctor too) a potentially serious condition like the ones that are mentioned above. Also, there are multiple conditions that may present like the satellite lesions (eg. bacillary angiomatosis, rocky mountain spotted fever, kapossi sarcoma, etc). My advise would be to remove them.

    September 15, 2010 at 23:55 | Report abuse | Reply
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  7. Kudzaishe Nyemba

    I had surgery for excision of pseudopterygium in my left eye four weeks ago. In the last two weeks a swelling occured in that eye in the position that the pseudopterygium had been and has been diagnosed as a pyogenic granuloma. Is this common, what caused it, could it be incorrect surgical procedure?

    December 15, 2010 at 11:00 | Report abuse | Reply
  8. Dragonfly

    .

    My nephew had a rather large pyogenic granuloma on his finger.
    His doctor told him it would not go away without surgery.

    My nephew lived with it for a couple of months [keeping it covered
    because it bled and to prevent infection.]

    Then all the sudden it began to shrink.
    It became smaller and smaller until it disappeared..
    It has not grown back.

    No surgery was required.

    .

    February 18, 2011 at 00:06 | Report abuse | Reply
    • Anca

      Dragonfly, please , tell me if your nephew had a tratment?....please respond

      April 6, 2011 at 12:33 | Report abuse |
  9. Audrey Chou

    My daughter who just turned 10 had her pyogenic granuloma surgically removed from her eye. I noticed that it is recurring in the same area after 2 months of surgery. Is there any way the doctor could treat it without my daughter going through surgery again? Please respond.

    May 31, 2011 at 22:35 | Report abuse | Reply
  10. Liz Harrison

    My bleeding Pyogenic Granuloma was on the base of my forefinger, and as I have a job which requires me to wash my hands frequently it was affecting my life.As I couldn't get an urgent appointment with my GP I paid £600.00 to see a specialist who cauterised it.A week later it started to grow and bleed again.He then repeated the cauterisation with same result.....I then managed to see my GP,which was free, who used silver nitrate twice in one week and hey presto it healed!..That was three years ago...So far so good!!

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  12. Ben Wolk

    I had a PG on the right side of my neck. It wasn't painful but it was fairly large and it had the classic symptom of bleeding profusely even when not touched or irritated. My doctor initially feared it was some form of melanoma, but after a ten-minute surgery to remove it, and a biopsy, it was revealed as a PG. I'm not at all certain what caused it, as I recall no injury to that area. This condition, if not dangerous or painful, is certainly an inconvenience, especially with the bleeding and the fact that a PG lesion isn't exactly pretty in social settings.

    March 11, 2013 at 19:17 | Report abuse | Reply
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    I had a pyogenic granuloma on the sole of my left foot. After months of bleeding and bandaging and irritation I had a doctor lance and drain the thing with this huge needle instrument causing a moment of the most extreme exquisite excruciating pain I've ever experienced. The area was cleaned and bandaged and healed rapidly and the hideous thing never returned again.

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    Now deceased husband diagnosed with pyogenic granuloma skin/subq on 10/25/12 in US. Had appt.for surgery on 10/30/12, when they would do biopsy. He decided to have surgery in Bangkok, Thailand because it would be one fifth the cost. Waited until 06/01/13 to go to the hospital in Thailand. Died 19 days later of malignant melanoma-Cancer of the spine, legs, liver, kidneys, went to his lungs, went into coma, then on lfe support, and died. WHAT HAPPENED HERE? If my husband had the original appt. on 10/30/12, would he still be alive? Was the granuloma a secondary sign of the Ca? Does Ca spread that fast? I HAVE NO ANSWERS! Should I obtain a lawyer?

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