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Pyogenic granulomas (PGs), usually solitary and isolated, have rarely been reported to arise as lesions within preexisting vascular malformations.1 Multiple, distinct, PG-like lesions within capillary or arteriovenous malformations (AVMs) have been described.2 To our knowledge, no cases of solitary or agminated PG-type growths have been reported in congenital hemangiomas (CHs).
A healthy male infant presented with a congenital, unchanged, asymptomatic, 2.5-cm, indurated, violaceous plaque with a surrounding blue to white halo on the right jawline (Figure 1A). No other hemangiomas were present. Ultrasonography showed a lobulated vascular mass with prominent flow, consistent with CH.
Findings of a subsequent complete blood cell count were normal. Three months later, the patient returned with bleeding and friable granulation tissue–like changes within the hemangioma (Figure 1B). Agminated PG overlying the preexisting CH was suspected. The superficial friable tissue and a portion of the primary lesion were excised.
Barrick B, Lehman J, Tollefson M. Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma. JAMA Dermatol. 2014;150(7):781–783. doi:10.1001/jamadermatol.2013.7530
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