Patient presentation: A fleshy or red mass that appears within a few months and bleeds very easily.
Any bleeding mass that appears within a short time frame and does not resolve absolutely needs to be seen by a physician.
But even more important, it needs to be biopsied or sent to pathology for a definitive diagnosis.
Pyogenic granulomas, thankfully, are benign masses that appear as a small red papule and then grows quickly within a short span of time. They can look pretty scary and they are an annoyance because they bleed and very easily.
The reason they bleed so easily is that it is an abnormal growth of vascular tissues and on the surface of the skin or mucosa. You can think of it as kind of like a knot of messy blood vessels.
It is most common in young adulthood but can appear at any age. For adults, the most common place they are seen are on the trunk or extremities. For kids and pregnant women, they are most commonly seen on the head and neck. In pregnant women especially, pyogenic granulomas appear in the mucosa of the oral cavity.
It is unclear why pyogenic granulomas come about. 25% are thought to come on as a result of medications such as retinoids, cetuximab, tacrolimus. Another almost 25% have a trauma trigger. A small percentage appear over pre-existing vascular malformation such as port wine stain. The majority, though, do not have a defined reason why they appear.
With the exception of pregnant women, most of these masses will NOT spontaneously resolve on their own. Pyogenic granulomas in pregnant women tend to resolve after the birth of their child.
For everyone else, the preferred mode of treatment is surgical excision. This is because pyogenic granulomas often recur if not completely removed. There is a role for both curettage, laser and topical beta blockers, but these have a higher recurrence rate than surgical excision.
