Pyogenic granuloma (PG) ranges from being asymptomatic to tender and painful. It may also bleed. Common sites are fingers, toes, lips, buccal mucosa, anal mucosa, and the upper aspects of the trunk. PGs measure 5 to 10 mm in diameter, are red to black (depending on trauma) and are often pedunculated, irritated, and friable (Fig. 48-1). PGs develop within a few weeks of injury to the site; they may also be caused by pregnancy or systemic retinoids. Despite the name, they are neither bacterial infections nor granulomatous, but are simply benign vascular hyperplasias. PGs are more common in children and young adults. They almost never involute spontaneously.