var captchapng = require('captchapng');
app.get('/sign/captcha.png', function(req, res) {
var captchaNumber  = parseInt(Math.random() * 9000 + 1000)
req.session.captcha = captchaNumber
var p = new captchapng(80,20, captchaNumber); // width,height,numeric captcha
p.color(0, 0, 0, 0); // First color: background (red, green, blue, alpha)
p.color(80, 80, 80, 255); // Second color: paint (red, green, blue, alpha)
var img = p.getBase64();
var imgbase64 = new Buffer(img,'base64');
res.writeHead(200, {
'Content-Type': 'image/png'
});
res.end(imgbase64);
})

$ npm install captcha
Usage (for Express 4)
'use strict'
const express = require('express')
const session = require('express-session')
const bodyParser = require('body-parser')
const captchaUrl = '/captcha.jpg'
const captchaId = 'captcha'
const captchaFieldName = 'captcha'
const captcha = require('./captcha').create({ cookie: captchaId })
const app = express()
app.use(session({
secret: 'keyboard cat',
resave: false,
saveUninitialized: true,
}))
app.use(bodyParser.urlencoded({ extended: false }))
app.get(captchaUrl, captcha.image())
app.get('/', (req, res) => {
res.type('html')
res.end(`
<img src="${ captchaUrl }"/>
<form action="/login" method="post">
<input type="text" name="${ captchaFieldName }"/>
<input type="submit"/>
</form>
`)
})
app.post('/login', (req, res) => {
res.type('html')
res.end(`
<p>CAPTCHA VALID: ${ captcha.check(req, req.body[captchaFieldName]) }</p>
`)
})
app.listen(8080, () => {
console.log('server started')
})