Treating A Patient With A Solitary Vascular Soft Tissue Mass On The Hallux

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Author(s): 
Kristine Hoffman, DPM

   Nodular melanoma presents as a rapidly enlarging red, black or skin colored lump that can have a smooth, rough or ulcerated surface.31 Nodular melanoma is the most aggressive type of melanoma with malignant cells that proliferate downward through the skin. It is the most important tumor to differentiate from pyogenic granuloma.

What You Should Know About Treating Pyogenic Granulomas

When it comes to pyogenic granulomas, there are several non-surgical treatment modalities, including topical agents, chemical cautery and intralesional injections.

   Both topical imiquimod cream and alitretinoin gel (Panretin, Eisai) are reportedly successful topical treatments for pyogenic granuloma.33,34 Chemical cauterization with silver nitrate and topical phenol are treatment options although a recurrence rate of up to 43.5 percent has occurred with cautery treatment.29,35,36 In addition, injectable sclerosing agents, intralesional steroids, intralesional bleomycin and photodynamic therapy with 5-aminolevulinic acid intralesional injection are reportedly successful treatment modalities for pyogenic granuloma and recurrent lesions.37-40 Following a retrospective review of treatment modalities, Lee and colleagues recommended cauterization with silver nitrate as the initial non-surgical treatment for pyogenic granuloma.41

   Several surgical options for the treatment of pyogenic granuloma exist. These treatments include shave, punch, curettage and scalpel excision. Researchers have also shown various laser modalities, as well as cryosurgery, to be successful treatment modalities for pyogenic granuloma.42,43 Full-thickness surgical excision has the lowest rate of recurrence at 2.94 percent and is the recommended treatment modality for smaller lesions in non-cosmetically sensitive areas.41

In Conclusion

Pyogenic granulomas are commonly occurring, benign skin lesions that are more appropriately called lobular capillary hemangioma. The lesions frequently arise secondary to trauma or pregnancy. The recommended treatment for pyogenic granuloma includes cauterization with silver nitrate and full thickness surgical excision.

   Dr. Hoffman is in private practice in Boulder, Colo.

References
1. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci. 2006;48(4): 167–75.

2. Freedberg IW, Eisen AZ, Wolff K, et al. Fitzpatrick's Dermatology in General Medicine, sixth edition. McGraw-Hill, New York, 2003.

3. Mills S, Cooper P, Fechner R. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. Am J Surg Pathol. 1980;4(5):471-479.

4. Strohal R, Gillitzer R, Zonzits E, Stingl G. Localized vs. generalized pyogenic granuloma. A clinicopathologic study. Arch Dermatol. 1991;127(6):856-61.

5. Itin PH, Fluckiger R, Zbinden R, Frei R. Recurrent pyogenic granuloma with satellitosis--a localized variant of bacillary angiomatosis? Dermatology. 1994;189(4):409-12.

6. Saad RW, Sau P, Mulvaney MP, James WD. Intravenous pyogenic granuloma. Int J Dermatol. 1993;32(2):130-2.

7. Fortna RR, Junkins-Hopkins JM. A case of lobular capillary hemangioma (pyogenic granuloma), localized to the subcutaneous tissue, and a review of the literature. Am J Dermatopathol. 2007;29(4):408-11.

8. Shah M, Kingston TP, Cotterill JA. Eruptive pyogenic granulomas: a successfully treated patient and review of the literature. Br J Dermatol. 1995;133(5):795-6.

9. Pierson JC, Tam CC. Dermatologic manifestations of pyogenic granuloma (lobular capillary hemangioma). Medscape. Available at http://emedicine.medscape.com/article/1084701 . Published Feb. 27, 2014. Accessed April 2, 2014.

10. Hemady N. Growing plantar lesion following trauma. Am Fam Physician. 2006;74(7):1173-1174.

11. Cheah S, DeKoven J. Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angioma. Australas J Dermatol. 2009;50(2):141-3.

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