Early 30s male patient has an area the size of a pin head 1mm subgingivally
on distolingual of an upper lateral incisor. The erythematous lesion seems
to be slightly elevated/swollen/hard when probed and is undetectable
exteriorly. The area is very sensitive to probing and bleeds excessively
upon exploration. The patient does not floss in between because flossing
causes pain and heavy bleeding? This has been present for at least 2 years
and has not changed in size since first noticed (according to the patient ).
Previous dentist insisted on more flossing and brushing, but I believe that
something should be done about it.

It certainly does not fit the trauma or infection category. Neoplastic?
Autoimmune?

To me it sounds and looks like a pyogenic granuloma and excison/curatage and
monitoring for reoccurrence would be the treatment of choice. Is it possible
that it's a hemangioma (tx conservative excision)?

What do you guys think? Is it necessary to refer and/or biopsy?

thanx