Granuloma like mass

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Dear Colleagues,

68 yr old female presnted with a hypergranulation like mass on the apex of her third toe. assuming it as a pressure ulcer i managed to offload it but the hypergranulation like tissue reoccurs. i suspect the hypergranulation like tissue could be instigated within.
ive attached the foot X-rays. radiologist reckons it is normal. My concern is the Sclerotic rim at the distal end of the 3rd toe. it appears as a reactive periosteal lesion on one view and as an exostosis on the other.

Any suggestions would be helpful?

Many thanks

Dave

 

Hi there Dave

If you are getting no improvement at all, it may be worth getting a biopsy done - could be an amelanotic melanoma. I inherited an elderly female patient recently with a hypergranulation mass post nail surgery which was unfortunately revealed as a malignant primary.

Hope not though
all the best
Mo

 

pyogenic granuloma

 

Had pyogenic granuloma confirmed by pathology lab recently. Plantar base of 2nd toe near web - initial presentation similar to 2mm small red naevus, few weeks later minor callus over area (unusual) and then became 10mm by 8mm by 4mm lesion projecting and bleeding. Flush cut the lesion and sent to lab. Diagnosis safe but the elderly lady still has the problem.

 

Thanks everyone for your input.
pyogenic granuloma: Ive offloaded the lesion and started pt on antibiotic therapy. (trauma and /or infection is thought to cause this lesion). Would using silver nitrate help? its another way of treating P.Granuloma. i will try this next week and update on the progress.

So, the sclerotic rim with lucent centre on the X-ray is normal?

Dave

 

Hyfrecation or lazer works well

 

Longer term follow up on pyogenic granuloma plantar aspect 2nd toe base - the lesion was excised under local and cauterised with surgical diathermy unit and now 3 months later there is no sign of the problem ie no scar either. (diathermy ovbiously wasn't aggressive)