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Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases
S J Patrice1, K Wiss, J B Mulliken
1Division of Plastic Surgery, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Pyogenic granulomas, also known as lobular capillary hemangiomas, are common in children. Full-thickness excision effectively treats these vascular lesions, significantly reducing recurrence rates compared to other methods.
Area of Science:
- Dermatology
- Pediatric Medicine
- Vascular Lesions
Background:
- Pyogenic granuloma (lobular capillary hemangioma) is a frequent acquired vascular lesion in pediatric patients.
- These lesions commonly affect the skin and mucous membranes.
Purpose of the Study:
- To analyze the clinical characteristics and treatment outcomes of pyogenic granulomas in pediatric patients.
- To compare the recurrence rates of different surgical interventions.
Main Methods:
- Retrospective analysis of 178 pediatric patients (≤17 years) with pyogenic granulomas.
- Data collected on patient demographics, lesion characteristics, location, and treatment modalities.
- Comparison of recurrence rates based on treatment: full-thickness skin excision versus shave excision with cautery.
Main Results:
- The male:female ratio was 3:2, with most lesions (42%) occurring before age five.
- Head and neck (62.4%) were the most common locations, predominantly on the skin (88.2%).
- Full-thickness skin excision resulted in zero recurrences, while shave excision had a 43.5% recurrence rate.
Conclusions:
- Pyogenic granulomas in children are common, particularly in the head and neck region.
- Full-thickness skin excision is a highly effective treatment with no recurrence.
- Shave excision with cautery is associated with a high recurrence rate and should be avoided.
Abstract:
Pyogenic granuloma (lobular capillary hemangioma) is a common acquired vascular lesion of the skin and mucous membranes in the pediatric age group. This is a retrospective analysis of 178 patients, 17 years of age and younger (mean age 6.7 yrs). Forty-two percent of the lesions occurred in the first five years of life; only 12% appeared in infants less than 1 year old. The male:female ratio was 3:2. Most patients (74.2%) had no history of trauma or predisposing dermatologic condition. The mean lesional size was 6.5 mm and the mean duration at diagnosis was 3.8 months. The granulomas were most commonly located in the head and neck area (62.4%), followed in order of decreasing frequency by trunk (19.7%), upper extremity (12.9%), and lower extremity (5.0%). The preponderance (88.2%) occurred on the skin, the remaining ones involved the mucous membranes of the oral cavity and conjunctivae. Histologic examination demonstrated normal numbers of mast cells, in contrast to increased mast cells characteristic of proliferative phase hemangiomas. Most lesions (n = 149) were treated by full-thickness skin excision and linear closure; there were no recurrences in this group. The recurrence rate in 23 lesions treated by shave (intradermal) excision and cautery or cautery alone was 43.5%.