History:

 This elderly woman presented with a solitary pedunculated 1 cm papulo-nodule on the upper lip, with tendency to bleed easily even with trivial trauma. DD..Pyogenic granuloma...Irritating fibroma (but the lesion soft rather than firm and bleeds with movement)....So final diagnosis is Pyogenic granuloma..The patient referred for surgical excision of the lesion with safety margin (to exclude the amelanotic melanoma)..Possibility of SCC excluded clinically as there was no induration, infiltration or chronic ulceration, but should be excluded as well as the age of the patient is risky....Finally a clinical tip tried to confirm the vascular nature of the lesion by photographing it in tension and non tension position...So a case of pyogenic granuloma.

This case is presented by Dr. Ayman Abdelmaksoud, MD, Egypt.