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JAMA Dermatology Clinicopathological Challenge
June 2017

A Bleeding Umbilicus in a Baby Boy

Author Affiliations
  • 1Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Dermatol. 2017;153(6):597-598. doi:10.1001/jamadermatol.2016.4684

An 8-month-old white male was seen for evaluation of a red, bleeding umbilical mass. The lesion had been present since loss of the umbilical stump at 1 week of life. It bled easily with Valsalva maneuver or trauma. The lesion was treated as an infantile hemangioma with timolol by an outside dermatologist and as an umbilical pyogenic granuloma with silver nitrate by the patient’s pediatrician, with minimal improvement. The patient was born at 38½ weeks by normal spontaneous vaginal delivery. His medical history was notable for tongue tie from birth. On examination, he was an alert and healthy-appearing child. The umbilicus demonstrated a bright red, friable, 5-mm papule (Figure, A). A shave biopsy specimen was obtained for histologic examination (Figure, B and C).

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