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Pyogenic granuloma vs amelanotic melanoma

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

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