Young girl plagued by bump on cheek

September 1, 2012

The father of a healthy 3-year-old girl begs you to help with a bleeding bump on her left cheek. It has been present for a few weeks but in the last 2 days has bled profusely on 3 occasions for more than 30 minutes each time.

Key Points

The Case

DIAGNOSIS: Pyogenic granuloma

Pyogenic granulomas, also known as lobular capillary hemangiomas, are common in children (especially toddlers).1 These benign, soft, bright red, usually solitary vascular neoplasms range in size from 2 mm to 2 cm and are often preceded by trauma to the involved area.2 Pyogenic granulomas typically exhibit rapid growth and bleed readily with minor trauma.

In children, 77% occur on the face or neck.1 They often develop a positive Band-Aid sign (contact irritant dermatitis in the shape of the dressing and surrounding adhesive needed to keep pressure on the hemorrhagic papule). Mean age of presentation is approximately 6 years, and 14% occur in the first year of life. Pyogenic granulomas rarely occur before 4 months. There is a slight male predisposition of 1.5:1, and white patients make up 84% of cases.

Pyogenic granulomas also tend to erupt on the buccal mucosa and gingivae of up to 2% of pregnant women during the first 5 months of pregnancy, perhaps because of hormonal influences.1,3 In this setting, they are referred to as granuloma gravidarum, or pregnancy tumor.3 Pyogenic granulomas may also occur with increased frequency over vascular malformations such as port wine stains, particularly after treatment with pulsed dye laser or during pregnancy.1,4

Historically, the name granuloma pyogenicum was used for this occurrence, because the lesion was presumed infectious and granulomatous but is actually neither.1 Although most clinicians still refer to these lesions as pyogenic granulomas, in 1980 the name lobular capillary hemangioma was introduced to reflect the pathophysiology of the benign vascular tumor.

Biopsy of the lesions shows a loose fibrous tissue matrix with proliferating capillaries similar to that of granulation tissue.1