Background: Pyogenic granulomas, when presented late, can sometimes pose diagnostic challenge due to their remarkably large sizes. There has been no known published data among Ghanaians on this subject. Aim: To determine the clinical, demographic, pathological features and management of oral pyogenic granuloma in a Ghanaian population. Methods: A retrospective study of records of 108 patients treated at the Korle Bu Teaching Hospital for histologically confirmed pyogenic granuloma between 1998 and 2010. Results: The male-to-female ratio was 1:1.16. The mean age was 31.2 years with a range of 9 months to 71 years. The peak age group was 11-20 years (23%). The Commonest site was the gingiva (58.33%), with a higher prevalence in the upper jaw, (42.59%). Other sites included the lips... (18.52%), buccal mucosa (10.19%) and tongue (8.26%). Majority presented late with symptoms such as bleeding, ulceration, infection and pain. In 58% of cases the lesions were pedunculated while in 42% they were sessile. Their consistencies ranged from soft and mobile to firm and rigid, with red surfaces. Their sizes ranged from a few millimetres to about 8 centimetres with a mean of 5.8 centimetres. They were treated by complete excision and no recurrences were noted in the few patients followed up. Conclusion: The clinical features found in this study were mostly similar to those in other studies. Most cases presented late, however, with remarkably larger sizes than generally reported from most other regions, and needed biopsy to conclude diagnosis. Simple surgical excision was used successfully in treating all cases.