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Case 81

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A 32-year-old female patient, otherwise healthy, sought for medical assistance due to a fast growing lesion on her right forehead. She reported that a “pimple” had previously arisen on the same region and that she had squeezed it. Since then, the resulting lesion had been presenting recurrent ulceration, easily bleeding and progressive growth.

Based on the clinical history and photograph presented herein, which is the most likely diagnosis?

a) Amelanotic melanoma

25%

b) Spitz nevus

25%

c) Pyogenic granuloma

25%

d) Botryomycosis

25%
   

Comments

- The pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes characterized by rapid growth and  a friable surface, which usually bleeds after minor trauma.

- The underlying etiology remains unknown, although some predisposing factors have been suggested, such as trauma, hormonal influences, growth factors and medications.

- It may occur at any age; however, incidence peaks in the second and third decades of life.

- Diagnosis is predominantly based on clinical features, even though histologic confirmation is always recommended.

- Choice of treatment hinges on many factors, such as size and location of the lesion.

References

- Coelho, WS; Diniz, LM; Souza Filho, JB. Botriomicose cutânea: relato de caso. An. Bras. Dermatol., Ago 2009, vol.84, no.4, p.396-399.
- Fonseca, Franklin Pinto; Savassi-Rocha, Paulo Roberto. Cirurgia ambulatorial. 3.ed. Rio de Janeiro: Guanabara Koogan, 1999. 667p.
- Lawley, LP. Pyogenic granuloma (Lobular capillary hemangioma). UpToDate.
Available at: http://www.uptodate.com/contents/pyogenic-granuloma-lobular-capillary-hemangioma 
- Pierson JC. Dermatologic Manifestations of Pyogenic Granuloma (Lobular Capillary hemangioma). Available at: http://www. /emedicine.medscape.com/article/1084701-clinical 
- Swetter, S; Geller, AC. Skin examination and clinical features of melanoma. UpToDate. Available at: http://www.uptodate.com/contents/skin-examination-and-clinical-features-of-melanoma

Author

Fernanda de Souza Foureaux, 5th year medical student (UFMG School of Medicine).

Email: fernandasfx[at]hotmail.com

Supervisors

Dr. Alexandre Lima de Barros. E-mail: dr.alexandre[at]medstetica.com.br       

Dr. Bernardo Gontijo, Professor of the Department of Internal Medicine (UFMG School of Medicine). E-mail: bernardogontijo[at]terra.com.br      

Reviewers

Júlio Guerra and Glauber Eliazar

Translated by

Lucas Resende Lucinda, 5th year medical student of UFMG School of Medicine. E-mail: lucasresendebh[at]hotmail.com

Commentics

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