Pyogenic granuloma on the upper lip: an unusual location

Abstract

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion. It is a reactional response to constant minor trauma and might be related to hormonal changes. In the mouth, PG is manifested as a sessile or pedunculated, resilient, erythematous, exophytic and painful papule or nodule with a smooth or lobulated surface that bleeds easily. PG preferentially affects the gingiva, but may also occur on the lips, tongue, oral mucosa and palate. The most common treatment is surgical excision. This paper describes a mucocutaneous PG on the upper lip, analyzing the clinical characteristics and discussing the features that distinguish this lesion from other similar oral mucosa lesions. The diagnosis of oral lesions is complex and leads the dentist to consider distinct lesions with different diagnostic methods. This case report with a 4 year-follow-up calls the attention to the uncommon mucocutaneous labial location of PG and to the fact that surgical excision is the safest method for diagnosis and treatment of PG of the lip, even when involving the mucosa and skin.

Figure 1

Reddish-yellow, ulcerated, superficial nodule involving the mucocutaneous line of the upper lip

Figure 2

Excisional biopsy to remove the nodule

Figure 3

Microscopic aspect showing an oral mucosa consisting of continuous parakeratinized, stratified pavement epithelium covered with a serofibrinous membrane. The underlying granulation tissue was rich in blood vessels, fibroblasts and macrophages. Skeletal striated muscle fibers were observed in the deep layers (Original magnification x 25)

Figure 4

Labial aspect 6 months (A) and 4 years (B) postoperatively