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?
Conditions Expert
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
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.
Next question:
Does eating gluten cause eczema?
CNN Comment Policy: CNN encourages you to add a comment to this discussion. You may not post any unlawful, threatening, defamatory, obscene, pornographic or other material that would violate the law. All comments should be relevant to the topic and remain respectful of other authors and commenters. You are solely responsible for your own comments, the consequences of posting those comments, and the consequences of any reliance by you on the comments of others. By submitting your comment, you hereby give CNN the right, but not the obligation, to post, air, edit, exhibit, telecast, cablecast, webcast, re-use, publish, reproduce, use, license, print, distribute or otherwise use your comment(s) and accompanying personal identifying and other information you provide via all forms of media now known or hereafter devised, worldwide, in perpetuity. CNN Privacy Statement.
The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.