Shave Excision With Silver Nitrate Cauterization Safe for PG Lesion Treatment

Shave excision combined with silver nitrate cauterization can be a better alternative to surgical excision in certain patients with pyogenic granuloma lesions.

Silver nitrate cauterization is a safe and reliable approach for treating pyogenic granuloma (PG) lesions, according to study findings published in Dermatologic Surgery.

Researchers conducted a prospective clinical trial and recruited patients (N=38) with cutaneous PG lesions from the Ankara Education and Research Hospital in Turkey between 2021 and 2022. Participants were randomly assigned to receive either shave excision with silver nitrate cauterization (n=20) or surgical excision with linear closure (n=18) performed in the office or surgical settings, respectively. Outcomes at 6 months were evaluated using the Patient-Observer Scar Assessment Scale (POSAS) and the Vancouver Scare Scale (VSS) instruments.

The study population comprised 52.6% men and boys, of whom 55.3% were aged 40 years and older, and 60.5% had lesions smaller than 5 mm. Most lesions were located on fingers (65.7%) or scalp (10.5%).

Stratified by group, the average lesion diameter was 5.6 mm and 5.33 mm and lesions onset at 2.29 months and 1.57 months among the shave and surgical excision groups, respectively.

The combination treatment of silver nitrate cauterization and shave excision is safe, reliable, and extremely effective for the treatment of PG lesions.

The shave intervention took an average of 5.14 (range, 4-7) minutes compared with 14.44 (range, 12-18) minutes for surgical excision (P <.05).

Complete resolution was observed among 18 of the silver nitrate recipients. The 2 participants without initial resolution achieved complete resolution after a second session.

Participants in the shave and surgical excision groups reported comfort scale scores of 9.4 points and 8.8 points and satisfaction scale scores of 9.7 points and 9.05 points, respectively, which did not differ significantly between cohorts. The shave excision was associated with superior POSAS total scores (mean, 14.6 points vs 28.6 points; P <.05) and VSS scores (mean, 0.75 points vs 3.44 points; P <.05) compared with surgical excision, respectively.

The shave excision intervention was significantly more cost-effective than surgical excision (mean, 219 Turkish Lira [TL] vs 624.7 TL; P <.05).

During an average follow-up of 9.44 months, no recurrence events were observed. One adverse event of wound dehiscence occurred in the surgical group.

Limitations of this study include the small sample size and the small number of pediatric patients.

Study authors conclude, “The combination treatment of silver nitrate cauterization and shave excision is safe, reliable, and extremely effective for the treatment of PG lesions. It allows the obtaining of tissue for histopathologic examination for an exact diagnosis. It also had better aesthetic results compared with surgical excision without any recurrence or complication. Silver nitrate treatment is fast to perform and has a low cost compared with surgical excision.”


Çelik M, Kara M, Özdemir AG, Kocer U, Çaydere M. Comparison of the efficacy of combined silver nitrate coagulation and shave excision with surgical excision and linear closure in the treatment of pyogenic granuloma. Dermatol Surg. Published online March 8, 2023. doi:10.1097/DSS.0000000000003748