Question:

A 31 year-old man developed a nodule on his left thumb for 3 months. It is neither painful nor itchy. The lesion grew rapidly to 0.5 cm in diameter and bled easily.

Answer: D. Pyogenic granuloma

Pyogenic granaloma is neither infective in nature nor granulomatous histologically. This common condition occurs possibly as a response to minor injury, though a history of injury may not be forthcoming in many cases. Typically the lesion evolves rapidly in weeks and appears as a pedunculated red or bluish nodule that bleeds easily. Histologically it is made up of proliferation of small blood vessels set in a stroma infiltrated by inflammatory cells. Treatment is surgical. Simple curettage of the lesion can be performed under local anaesthesia. Bleeding can be controlled with cauterisatiion. It can also be treated by surgical excision or cryosurgery. Local recurrence after surgery is infrequent but patient should be forewarned.