Pyogenic Granuloma Following Toenail Avulsion Surgery: A Case Report

Pyogenic granuloma is a benign vascular proliferation that often develops following trauma or surgical procedures, particularly in acral and periungual regions. These lesions can mimic infectious or malignant processes, and their occurrence in the periungual area warrants careful evaluation due to the potential for diagnostic uncertainty. The following case discusses a 76-year-old woman who developed a pyogenic granuloma at the site of a toenail avulsion. She presented with a nonhealing, intermittently bleeding lesion on the lateral border of the left great toenail. Clinical examination revealed a friable erythematous papule beneath a hemorrhagic crust. Gross pathologic examination demonstrated a hemorrhagic, crusted, dome-shaped lesion, and the final pathologic diagnosis was pyogenic granuloma. The lesion was managed successfully with shave biopsy, electrodessication, and Monsel's solution. This case suggests that gentle removal of an overlying surface crust, when clinically appropriate, may improve assessment of the underlying lesion and facilitate accurate diagnosis. Recognition of this condition can help physicians provide timely intervention, prevent complications, and improve patient outcomes.