Lobular capillary hemangioma (LCH) is a specific entity among vascular lesions of the head and neck that may be diagnosed loosely as "pyogenic granuloma". In contrast to granulation polyps and other reactive conditions, LCH is now regarded as likely a benign vascular neoplasm. Recent series assert lack of postoperative recurrence of LCH. We have observed otherwise, and to clarify this issue performed a systematic review of our institutional experience with LCH, tabulating clinicopathologic, histologic, and follow-up parameters of nasal or sinus lesions diagnosed as LCH or PG between 1989 and 2009. Lesions meeting strict criteria for LCH were included, and statistical analyses were performed using t tests, χ2 tests, and Kaplan-Meier analysis. Of cases identified, 38 of 46 (86%) met criteria for LCH. Presenting symptoms included epistaxis (75%), obstruction (36%), and pain (3%), with no sex predilection (17/17; M/F), and a median age of 39 years. Pregnancy was associated with 5/34 (15%) cases, while antecedent trauma was reported in 4/34 (12%). Histologically, ulceration was frequent (68%) and mitotic activity highly variable (0-38 mitoses/10 HPF). Of cases with follow-up (31/34), we observed 13 local recurrences (42%), including unbiopsied clinical recurrence (6/31, 19.4%) and biopsy-documented recurrence (7/31, 22.6%). Subjects with recurrence were significantly older (P = 0.04). Demographic, clinical, and histopathologic features were similar to prior studies; in contrast to recent series, recurrence in this cohort was frequent and comparable to that originally reported. Awareness of this may aid in avoiding misdiagnosis of these lesions as more aggressive entities such as angiofibroma and angiosarcoma.