The latest in GP and hospital practitioner Dr Andy Jordan's series on differentiating two often similar-looking skin conditions
Both conditions present with bleeding vascular nodules, which are usually painless. But a pyogenic granuloma is benign, whereas amelanotic melanoma requires excision, histological staging and regular review.
Pyogenic granuloma
• Occurs at any age, but rare in the elderly
• Typically occurs on fingers, lips or face
• Develops rapidly, often at the site of a minor injury
• Gives rise to intermittent heavy bleeding
• Bright red-brown to blue-black in colour
• Often on a small stalk, with a collar around the base
• Surface is crusted and eroded and often very friable
• Treatment consists of double curettage and cautery
• Occasionally recurs
• Specimens must always be sent for histology – it may turn out to be an amelanotic melanoma.
Amelanotic melanoma
• Very rare in childhood, but more likely than pyogenic granuloma in the elderly
• Often occurs under the nail or as a fleshy nodule on the sole of the foot
• If subungual, often bleeds easily and causes nail damage
• Appears as a pink nodule in which there may be a fine ring of pigment
• Differential diagnosis includes basal cell carcinoma or squamous cell carcinoma
• Wide excision is the treatment of choice – if uncertain of diagnosis, refer early.
Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire
amelanotic melanoma amelanotic melanoma Pyogenic granuloma Pyogenic granuloma
