Granuloma Gravidarum on the Post-Excisional Scar for an Atypical Melanocytic Lesion During Pregnancy

Introduction: Granuloma gravidarum represents a rare lesion, defined as a reactive vascular hyperplasia of pregnancy, that affects mainly the oral mucosa. Very few cases were reported on non-mucous sites. Case presentation: We present the case of a 32-year-old, 18 weeks pregnant patient, that developed a granuloma gravidarum on the excision scar of a volar atypical melanocytic lesion. She presented to the dermatology department with a recently developed melanocytic lesion on her left heel. Dermoscopy showed asymmetry and brown globules in a ring pattern. The lesion was excised with 5 mm margins, under local anesthesia and sedation. The path report and immunohistology revealed a dysplastic melanocytic acral nevus. The excision site closed nicely, but after 5 days a red friable 0,5 cm vascular bleeding tumor developed in one extremity of the scar. Patient refused biopsy. The new tumor raised diagnostic difficulties between a vascular lesion and an amelanotic recurrence of the melanocytic lesion. Due to the path report which showed a benign pigmented lesion and because the lesion was excised completely, granuloma gravidarum was suspected. Patient received local antibiotic treatment and the vascular lesion involuted completely after 3.5 weeks. Conclusion: Pregnant women are at high risk of developing vascular tumors at trauma sites, due to hormonal changes. It’s important to be aware of this surgery complication in pregnant patients, as evolution is usually benign and complete spontaneous resolution is possible.