Pyogenic granuloma-treatment by shave-excision and/or pulsed-dye laser

We present the results of our evolving treatment strategy for pyogenic granuloma (PG) affecting cosmetically sensitive areas, from 1996 to 2007. Fifty-one lesions in 49 patients aged six weeks to 87 years (mean, 23.5 years) affecting the head and neck skin (39%) and lip vermillion (14%), limbs (31%) and trunk (16%) were treated. Fifteen lesions (29%) had failed previous treatments elsewhere. Forty-two lesions (in 40 patients) underwent pulsed-dye laser (PDL) therapy alone, using fluences of 5.3-9.4 J/cm(2) (Photogenica V) or 15 J/cm(2) (V-Beam) without dynamic cooling, at 7 mm spot-size. An average of 1.8 (range, 1-5) treatment sessions were required for lesions <5 mm, while an average of 2.7 (range 1-6) sessions were needed for lesions 5-10 mm in size. Five patients (with five lesions) measuring 4-6 mm elected for surgical excision following 1-3 (mean, 1.7) PDL treatments. Since 2001, nine PG (in nine patients) measuring 5-20 (mean, 11) mm underwent shave-excision and immediate PDL and repeat PDL as necessary. One patient elected for surgical excision following two PDL sessions. The remaining eight patients required an average of 1.1 (range, 0-5) additional PDL sessions for eradication of their PG. PDL alone for PG <5 mm, and shave-excision and immediate PDL to the base for larger lesions are effective treatments for lesions affecting cosmetically sensitive areas.