Quiz
Skin conditions due to fungi, bacteria and viruses – 10 cases

Pyogenic granuloma, an angioproliferative response to bacterial colonisation of a wound.

The referring doctor's main concern was a rapidly growing nodular melanoma, assuming the black colour to be due to melanin. Other malignant tumours should also be considered. However, vascular lesions such as angiokeratoma, Kaposi's sarcoma and capillary angiomas are sometimes also black because of eschar.

The diagnosis must be established histologically and can be obtained by shave, punch, incisional or excisional biopsy. Pyogenic granuloma is not actually a granuloma, but is characterised by granulation tissue. This is vascular proliferation in a pale stroma with sparse mixed inflammatory infiltrate. The epidermis can be atrophic or ulcerated and in this case was topped by adherent eschar. The lesion is surrounded by a collarette of regenerating epidermis.

This lesion was shaved off, the base was curetted and then lightly electrodessicated (Figure 2).

The patient was warned there was up to 50% chance of recurrence, especially with further injury or wound infection. Luckily it re-epithelialised fully within two weeks and did not recur.