Photo Quiz

Teenager with a Bleeding, Red Papule


Am Fam Physician. 2016 Feb 1;93(3):223-224.

A 14-year-old boy presented with a tender red papule on his finger. He first noticed it two months earlier. It bled several times, especially when rubbed by his baseball mitt. He had no medical problems or allergies, and he was not taking any medications. He had no other similar skin lesions, and the review of systems was negative for bleeding problems, easy bruising, and frequent infections.

Physical examination revealed a solitary bright-red papule on the distal lateral portion of his left fifth finger (Figure 1). On dermoscopy, the lesion was homogeneously red and surrounded by a white collarette of scale (Figure 2). There was no evidence of a pigment network, pigment globules, or dotted vessels.

Figure 1.

Figure 2.


Based on the patient's history, physical examination, and dermoscopy findings, which one of the following is the most likely diagnosis?

A. Amelanotic melanoma.

B. Hemangioma.

C. Pyogenic granuloma.

D. Spitz nevus.

E. Wart.


Address correspondence to Elizabeth Seiverling, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Dermal and subcutaneous tumors. In: James WD, Elston DM, Berger TG, Andrews GC, eds. Andrews' Diseases of Skin: Clinical Dermatology. 11th ed. London, United Kingdom: Saunders Elsevier; 2011:583–584....

2. Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. Br J Dermatol. 2006;154(6):1108–1111.

3. Zaballos P, Carulla M, Ozdemir F, et al. Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010;163(6):1229–1237.

4. Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004;21(1):10–13.

5. Argenziano G, Zalaudek I, Corona R, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol. 2004;140(12):1485–1489.

6. Haliasos EC, Kerner M, Jaimes N, et al. Dermoscopy for the pediatric dermatologist, part ii: dermoscopy of genetic syndromes with cutaneous manifestations and pediatric vascular lesions. Pediatr Dermatol. 2013;30(2):172–181.

7. Kerner M, Jaimes N, Scope A, Marghoob AA. Spitz nevi: a bridge between dermoscopic morphology and histopathology. Dermatol Clin. 2013;31(2):327–335.

8. Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol. 2009;160(1):220–222.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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