Painful fingertip tumor in pregnancy

This friable vascular papule was most consistent with a lobular capillary hemangioma (LCH), also called a pyogenic granuloma. A shave biopsy was performed at the base of the tumor to confirm the diagnosis and rule out malignant pedunculated tumors, including nodular melanoma, angiosarcoma, and metastatic carcinoma.

LCHs are benign vascular growths that occur on the skin and mucosa, most often in children and young adults. Growth may occur rapidly over days to weeks and tumors may grow to several centimeters in size. Although LCHs are often painless, they do tend to bleed easily with minor trauma.

While the triggering mechanism is unknown, LCHs have been associated with infection, trauma, hormonal factors (especially in the second and third trimesters of pregnancy), and therapy with retinoids. About 5% of pregnancies are associated with the development of an LCH on the oral mucosa, usually in the second or third trimester.¹

Treatment of LCHs is based on small case series and case reports. Individual tumors have a high likelihood of recurrence after a single treatment, so multiple visits for treatment are often recommended. Electrocautery is safe and effective with complete cure occurring after 2 sessions. Similarly, cryotherapy is safe and effective with excellent results after 3 treatment sessions. Cryotherapy may cause depigmentation in patients with darker skin types, so this should be discussed with patients with skin of color. Excision of small lesions is also safe and effective in a single session.²

This patient was treated with light electrodessication and curettage in 2 sessions with complete clearance.

‌

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.

This friable vascular papule was most consistent with a lobular capillary hemangioma (LCH), also called a pyogenic granuloma. A shave biopsy was performed at the base of the tumor to confirm the diagnosis and rule out malignant pedunculated tumors, including nodular melanoma, angiosarcoma, and metastatic carcinoma.

LCHs are benign vascular growths that occur on the skin and mucosa, most often in children and young adults. Growth may occur rapidly over days to weeks and tumors may grow to several centimeters in size. Although LCHs are often painless, they do tend to bleed easily with minor trauma.

While the triggering mechanism is unknown, LCHs have been associated with infection, trauma, hormonal factors (especially in the second and third trimesters of pregnancy), and therapy with retinoids. About 5% of pregnancies are associated with the development of an LCH on the oral mucosa, usually in the second or third trimester.¹

Treatment of LCHs is based on small case series and case reports. Individual tumors have a high likelihood of recurrence after a single treatment, so multiple visits for treatment are often recommended. Electrocautery is safe and effective with complete cure occurring after 2 sessions. Similarly, cryotherapy is safe and effective with excellent results after 3 treatment sessions. Cryotherapy may cause depigmentation in patients with darker skin types, so this should be discussed with patients with skin of color. Excision of small lesions is also safe and effective in a single session.²

This patient was treated with light electrodessication and curettage in 2 sessions with complete clearance.

‌

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.

This friable vascular papule was most consistent with a lobular capillary hemangioma (LCH), also called a pyogenic granuloma. A shave biopsy was performed at the base of the tumor to confirm the diagnosis and rule out malignant pedunculated tumors, including nodular melanoma, angiosarcoma, and metastatic carcinoma.

LCHs are benign vascular growths that occur on the skin and mucosa, most often in children and young adults. Growth may occur rapidly over days to weeks and tumors may grow to several centimeters in size. Although LCHs are often painless, they do tend to bleed easily with minor trauma.

While the triggering mechanism is unknown, LCHs have been associated with infection, trauma, hormonal factors (especially in the second and third trimesters of pregnancy), and therapy with retinoids. About 5% of pregnancies are associated with the development of an LCH on the oral mucosa, usually in the second or third trimester.¹

Treatment of LCHs is based on small case series and case reports. Individual tumors have a high likelihood of recurrence after a single treatment, so multiple visits for treatment are often recommended. Electrocautery is safe and effective with complete cure occurring after 2 sessions. Similarly, cryotherapy is safe and effective with excellent results after 3 treatment sessions. Cryotherapy may cause depigmentation in patients with darker skin types, so this should be discussed with patients with skin of color. Excision of small lesions is also safe and effective in a single session.²

This patient was treated with light electrodessication and curettage in 2 sessions with complete clearance.

‌

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME.