Pictorial case study

Dr Jean Watkins, a sessional GP in Hampshire

The case
This 79-year-old man was concerned about a red, fleshy lump that had appeared at the base of the index finger of his right hand. He had first noticed what he called a small 'mole' about six weeks before, but it had rapidly increased in size and now bled if he knocked it. He did wonder if it was anything to do with scraping his hand on the garden shed just before it appeared.

On examination, the bright red, dome-shaped, clearly demarcated, pedunculated lesion was smooth and firm to the touch.

Diagnosis and management
Pyogenic granuloma is a common problem. It may occur at any age but tends to be more common in women, especially in pregnancy. This lobular capillary haemangioma often follows a minor injury such as a prick from a rose thorn.

Suggestive points are the rapid development of the lesion within a few weeks, recent injury to the body part, and a recent history of bleeding from it.

If trauma does not induce bleeding, it is unlikely to be a pyogenic granuloma. Biopsy and removal is recommended to ensure a malignancy is not overlooked. Cryotherapy or topical silver nitrate are used for small lesions but recurrence is high.

Possible different diagnoses

  • Squamous cell carcinoma.
  • Glomus tumour.
  • Kaposi sarcoma.
  • Metastatic carcinoma.

Differential diagnosis

  • Solitary glomus tumour
  • Benign tumour thought to arise in glomus cells.
  • Cause unknown but may follow trauma.
  • Most commonly occur on the fingers and toes, especially under the nails.
  • Present as blue or purple, well demarcated papules or nodules that blanch on pressure.
  • Up to 1cm in diameter.

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