Giant pyogenic granuloma

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Figure. A 51-year-old woman with chronic graft-versus-host disease presented with foot and ankle ulcers (A) 5 years after receiving an allogenic hematopoetic stem cell transplant because of acute myeloic leukemia. The same ankle is shown 1 month (B) and 2 months (C) later.

This rapidly growing lesion was surgically excised, and histopathologic analysis confirmed the diagnosis of a giant pyogenic granuloma.

Pyogenic granulomas are benign, exophytic, vascular tumours first described by Poncet and Dor in 1897. A solitary pyogenic granuloma is common, and it can grow rapidly from few millimetres to several centimetres within a few weeks' time. Although the exact pathogenesis is unknown, pyogenic granulomas are closely related to trauma, chronic irritation and hormonal changes. Patients often describe repeated episodes of profuse bleeding from the tumour after minor trauma. Because pyogenic granulomas can mimic malignant diseases, a biopsy should be performed.¹

Nonsurgical treatment options, such as laser therapy or cryotherapy, are associated with recurrence rates of up to 50%. Therefore, complete excision is the first-choice therapy.

Joachim Dissemond MD Stephan Grabbe MD Department of Dermatology University of Essen Essen, Germany