Junck M, Huerter CJ, Sarma DP. (2011). Unknown: Rapidly growing hemorrhagic papule on the cheek of a 54-year-old man. Dermatology Online Journal 17(1): 11. PubMed PMID: 21272502


A 54-year-old man sought medical attention for a growth on his right cheek that had been present for three months. The growth began as a small, brown “pimple” that gradually increased in size over time. Physical examination revealed a 9 mm well-circumscribed erythematous nodule with a hemorrhagic crust. On dermoscopy, the lesion was completely vascular appearing, with no pigment visualized. A clinical diagnosis of pyogenic granuloma was made. The lesion was biopsied and histopathologic examination revealed a 2.8 mm thick, Clark level IV, ulcerated, amelanotic nodular melanoma. Because the literature contains reports of nodular melanoma mimicking the presentation of a pyogenic granuloma, all such lesions should be biopsied for histopathologic diagnosis.

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