Post-Trauma Lesions

A 16-year-old boy removed a small sliver of wood from the palm of his hand with a pocket knife. However, the fledgling “surgeon” created a small puncture wound during this operation. Over the next month, a small, moist, friable papule grew at the site (A).

The lesion failed to heal. Slight trauma to the papule caused brisk bleeding and pain.

A 27-year-old man noted this papule (B) on his finger a few weeks after he had removed a fishing hook from the site. The lesion was intensely red, pedunculated, and bled easily with provocation.

Minor trauma to a 37-year-old woman's left palm preceded the eruption of a slow-growing nodule at the same site (C). The discrete, violaceous lesion had an eroded surface and collarette of epidermis.

These lesions are pyogenic granulomas. Specimens of material from shave biopsies confirmed the diagnoses. The epidermal collarette around the base of the papule-while not invariably present or exclusive to pyogenic granulomas-is a clue to the diagnosis.

A pyogenic granuloma is a vascular proliferation that may be ulcerated and is seen frequently in children. Hands are common locations for these lesions, but they may arise on the scalp (particularly after chickenpox) and nipples or accompany ingrown toenails.

Pathologic examination of these papules is necessary to exclude nodular malignant melanoma, which is included in the differential. A shave biopsy and curettage or excision and electrocautery are usually curative.