Will pyogenic granuloma on scalp bleed on scratching?

Hello,

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I have seen the image (attachment removed to protect patient identity) and read your given history. From both, it looks like a pyogenic granuloma itself. Be aware that the causes of its development are bacterial/fungal infection, or trauma induced following minor injuries and abrasions, or hormonal imbalance, or drug induced due to certain drugs like oral retinoids. Color of pyogenic granuloma lesions can vary anywhere between pale red to red to brown because the lesions involve underlying capillaries and blood vessels. For the same reason, it bleed on touch and can bleed occasionally. Since the lesion is present for three months and is increasing in size, the best option to consider would be surgical excision biopsy, where after the excision the lesion would be sent to test for malignant potential (highly unlikely) just to be sure of things. Other options to consider are laser-assisted removal, cryotherapy, and cauterization. Topical therapy with Imiqumoid and Propranolol is available but it has poor response as it may take a long period of time. As I mentioned earlier, excision biopsy would be the best option for you. And seeing the image, there is no reason to worry about it after the excision. I hope this helps.