Seborrheic Keratosis Mimicking Pyogenic Granuloma

A 57-year-old man presented for medical evaluation because of the presence of a "funny looking lump" on the lateral aspect of his right upper thigh. The lesion bled when traumatized but was otherwise asymptomatic.

Key point: The beefy-red color and history of friability strongly suggests a vascular neoplasm, such as a pyogenic granuloma. However, a biopsy revealed a severely inflamed and edematous seborrheic keratosis!

Treatment: Although the lesion was benign, the patient requested its removal to prevent continued bleeding episodes. The tumor was removed via deep shave, followed by vigorous electrodesiccation to the base. There has been no recurrence.

Note: Gross morphology of skin lesions should always be considered suggestive and not diagnostic. The correct nature of this lesion was not suspected by a very experienced clinician.