A Sheep in Wolf’s Clothing: Lobular Pyogenic Granuloma Masquerading Nodular Amelanotic Melanoma
Abstract
BACKGROUND: Tumor masquerading is a common phenomenon seen in clinical dermatology. While amelanotic melanoma is known to simulate pyogenic granuloma, a benign vascular tumour, the contrary has been reported exceptionally scarce.
CASE PRESENTATION: We present a 52-year-old woman with a slow-growing lesion on her right flank, which developed over 12 months. On examination, we observed a large exophytic, easily bleeding tumour on the right flank, that resembled amelanotic malignant melanoma. Histologic analysis after complete excision of the lesion confirmed a pyogenic granuloma of the lobular capillary hemangioma subtype. In the present case masquerading of the lesion went to the better site after histologic investigations despite the delay of diagnosis caused by the patients.
CONCLUSION: Nevertheless, the diagnosis of uncertain lesions needs a rapid histologic analysis to gain the best possible prognosis for the patient.
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References
Godfraind C, Calicchio ML, Kozakewich H. Pyogenic granuloma, an impaired wound healing process, linked to vascular growth driven by FLT4 and the nitric oxide pathway. Mod Pathol. 2013; 26:247-55. https://doi.org/10.1038/modpathol.2012.148 PMid:22955520
Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G. Pyogenic granuloma - a common benign vascular tumor with variable clinical presentation: new findings and treatment options. Open Access Maced J Med Sci. 2017; 5:423-6. https://doi.org/10.3889/oamjms.2017.111 PMid:28785323 PMCid:PMC5535648
Cawson RA, Binnie WH, Speight PM, Barrett AW, Wright JM. Lucas Pathology of Tumors of Oral Tissues. 5th. St. Louis, Mo, USA: Mosby, 1998.
Marla V, Shrestha A, Goel K, Shrestha S. The histopathological spectrum of pyogenic granuloma: a case series. Case Rep Dent. 2016; 2016:1323798. https://doi.org/10.1155/2016/1323798 PMid:27382492 PMCid:PMC4921146
Charles NC, Kahn JB. Infarcted tarsal pyogenic granuloma simulating malignant melanoma. Ophthalmic Plast Reconstr Surg. 2017; 33(3S Suppl 1):S33-4. https://doi.org/10.1097/IOP.0000000000000525 PMid:26164159
Zaballos P, Rodero J, Serrano P, Cuellar F, Guionnet N, Vives JM. Pyogenic granuloma clinically and dermoscopically mimicking pigmented melanoma. Dermatol Online J. 2009; 15:10.
Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J, Llambrich A, Puig S, Argenziano G, Malvehy J. Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010; 163:1229-37. https://doi.org/10.1111/j.1365-2133.2010.10040.x PMid:20846306
Tchernev G, Chokoeva AA, Terziev I, Grigorov Y, Lotti T, Wollina, U, Cardoso JC, Yungareva I, Lozev I, Maximov GK. Small dysplastic congenital melanocytic nevi in childhood as possible melanoma imitators. Open Access Maced J Med Sci. 2018; 6:149-51. https://doi.org/10.3889/oamjms.2018.018 PMid:29484015 PMCid:PMC5816289
May C, LeBoit P, McCalmont T, Argenyi Z. Hypercellular encapsulated neuroma imitating desmoplastic melanoma. Am J Dermatopathol. 2019; 41:358-60. https://doi.org/10.1097/DAD.0000000000001302 PMid:30531539
Koch SE, Lange JR. Amelanotic melanoma: the great masquerader. J Am Acad Dermatol. 2000; 42:731-4. https://doi.org/10.1067/mjd.2000.103981 PMid:10775846
Moshe M, Levi A, Ad-El D, Ben-Amitai D, Mimouni D, Didkovsky E, Feinmesser M, Lapidoth M. Malignant melanoma clinically mimicking pyogenic granuloma: comparison of clinical evaluation and histopathology. Melanoma Res. 2018; 28:363-7. https://doi.org/10.1097/CMR.0000000000000451 PMid:29750750
Copyright (c) 2019 Jacqueline Schönlebe, Uwe Wollina (Author)

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