TOPLINE:

In a retrospective study, invasive amelanotic melanoma was detected in 1.5% of lesions clinically and dermoscopically suspected as pyogenic granuloma (PG). Older age and lesions located on the limbs were associated with higher misdiagnosis rates.

METHODOLOGY:

• This retrospective study included 479 lesions from patients (mean age, 34.9 years; 56.8% males; 27.3% children) with a preoperative diagnosis of PG between January 2015 and 2025.
• All lesions were surgically excised, followed by histopathologic examination, and the frequency of melanoma was evaluated. Risk factors associated with high misdiagnosis rates were also analysed.

TAKEAWAY:

• Alternative diagnoses were confirmed in 43 lesions (9%); among the 43 misdiagnosed lesions, 16 (37.2%) were melanocytic lesions. Overall, seven lesions (1.5%) were confirmed as invasive melanomas.
• Patients with misdiagnosed lesions were significantly older than those with correctly diagnosed PG (mean age, 45.5 vs 33.7 years; P = .0005). Lesions located on the limbs were associated with a higher misdiagnosis rate than those located on the trunk (6.1% vs 1.7%; P = .0006).
• Age (odds ratio [OR], 1.023; P = .004) and limb location (OR, 6.1; P = .002) were independent predictors of misdiagnosis, and the trunk location was associated with a lower risk for misdiagnosis (OR, 0.54; P = .03).

IN PRACTICE:

"While this percentage [melanoma detection] may seem low, it is clinically relevant due to the potential morbidity and mortality associated with delayed amelanotic melanoma diagnosis," the authors wrote.

SOURCE:

This study was led by Camila Scharf, Dermatology Unit, University of Campania L.Vanvitelli, Naples, Italy. It was published online on November 14, 2025, in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

This study was limited by its retrospective nature and the absence of systematic dermoscopic pattern analysis. Additionally, kinetic data, such as trauma history and growth speed information, were lacking, which could have provided valuable insights into the diagnostic process.

DISCLOSURES:

This study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.