In this video blog, Lisa Swanson, MD , briefly discusses highlights from her lecture, Pediatric Lumps and Bumps , given on November 9, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

In this interview with PA Lisa Weiss, Dr. Lisa Swanson ("Lisa Squared") walks through gentler approaches to pediatric pyogenic granulomas, noting that shaving and cauterizing is fine but "the younger the patient is, and depending on the location, the less desirable that might be" — especially near the eye. She favors topical timolol 0.5% (one drop, dabbed on twice daily), which stops the nuisance bleeding quickly and can fully resolve the lesion over two to three months. She schedules a one-month follow-up, and if there's no improvement, she recommends biopsy since other entities can mimic a pyogenic granuloma. Her removal tips include "big fat" OB/GYN Q-tips, Gradle scissors instead of a blade in kids, and a "mandatory snack policy" for teenage boys after biopsies.

Dr. Swanson explains that eclipse nevi — moles with a darker center and lighter rim (or vice versa) — are extremely common on the scalps of children and can always be left alone. She notes they're often read out as "mildly atypical" because the pediatric scalp is a special site not recognized as such by dermatopathologists, which only "muddies the waters" and can lead to an unnecessary scalp excision. Finally, she offers a fast bedside pearl for distinguishing a corn from a wart: press down and it hurts, it's a corn; squeeze the sides and it hurts, it's a wart.

  • For pediatric pyogenic granulomas in young children or precarious locations, topical timolol 0.5% (one drop dabbed on twice daily) stops the bleeding fast and resolves the lesion over two to three months.
  • Schedule a one-month follow-up; if there's no improvement on timolol, do a shave biopsy, since other entities can mimic a pyogenic granuloma.
  • Prescribe the timolol gel-forming solution but note that substitution for the eye drops is okay if needed — it's cheap and well covered by insurance.
  • Eclipse nevi on the scalp are common, benign moles that can always be left alone; biopsy often yields a misleading "mildly atypical" read and an unnecessary excision.
  • To tell a corn from a wart: if pressing down hurts, it's a corn; if squeezing the sides hurts, it's a wart.