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What's the lesion on this woman's finger?

A pregnant woman was worried about caring for her baby with this lesion on her finger. Dr Mike Wyndham describes another case

 

The patient

This 29-year-woman in the latter stages of pregnancy came to surgery one morning with the care of her future baby on her mind. She complained that she had developed a swelling on one of her fingers which had grown over the past few months to about a centimetre in diameter.

It also oozed occasionally but had not bled significantly and surprisingly caused little pain. She was particularly concerned that this would interfere with looking after her baby. She asked that it should be removed as soon as possible.

First instinct

Well I had to agree with her. The idea of an open lesion which might bleed on to the baby would be somewhat disconcerting. The question was whether I was sure enough about the diagnosis to remove it in practice rather than refer to the clinic with possible delays – and be too late.

Differential diagnosis

• Nodular melanoma

• Pyogenic granuloma

• Solitary glomus tumour

As the name suggests, nodular melanoma is a raised lesion. It may grow rapidly, which fits with the history. But the lesion is more common in men, occurs most commonly around the age of 50 and is more likely to affect the trunk and legs. It may be prone to bleeding. The latter facts made it an unlikely diagnosis.

A pyogenic granuloma is a vascular lesion that usually develops on the head, neck, fingers, palms and soles – certainly fitting this case.

Solitary glomus tumours usually have a bluish appearance and are less than a centimetre in diameter. They may be particularly painful, made worse with the application of pressure. They are prone to developing under nails. This lesion did not seem to be the one she had. On balance, the likelihood was that this was a pyogenic granuloma.

Getting on the right track

With the possibility of a pyogenic granuloma in mind, I checked to see if there was a history of trauma. To my pleasant surprise, she confirmed that she had cut her finger quite badly with a sharp knife a few weeks earlier which supported the diagnosis. This was later confirmed after removal of the lesion.

Dr Mike Wyndham is a GP in Edgware, north London

What's this lesion?

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