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Dermatology > DISEASES OF THE VESSELS
Cherry Hemangioma
Article Last Updated: May 9, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Clarence William Brown Jr, MD, Assistant Professor of Dermatology, Director of Mohs Micrographic and Dermatological Surgery, Rush University Medical Center
Clarence William Brown, Jr, is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Editors: Evan R Farmer, MD, Professor of Dermatology, Johns Hopkins University School of Medicine, Clinical Professor of Pathology, Virginia Commonwealth University School of Medicine; Consulting Staff, Department of Dermatology, Johns Hopkins Hospital, VCU Health Services; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
Author and Editor Disclosure
Synonyms and related keywords:
Campbell de Morgan spots, senile angiomas
Background
Cherry hemangiomas are the most common cutaneous vascular proliferations. They are often widespread and appear as tiny cherry red papules or macules.
Pathophysiology
Involvement of cherry hemangiomas is limited to the skin. These benign lesions are formed by a proliferation of dilated venules.
Frequency
United States
Frequency of cherry hemangiomas increases with age in both sexes and all races.
International
The incidence of cherry angiomas is uniform across all races, but individual lesions are most noticeable in pale-skinned individuals.
Mortality/Morbidity
- Lesions are benign and usually do not undergo spontaneous involution.
- Patients may demonstrate considerable concern regarding the cosmetic appearance of the lesions.
Race
Cherry hemangiomas are found in individuals of all races and ethnic backgrounds.
Sex
No distinction can be made on the basis of sex.
Age
Cherry hemangiomas occur more frequently with increasing age. In the past, the lesions often were referred to as senile angiomas.
History
Cherry angiomas typically present in the third or fourth decades of life, and early lesions may appear as small red macules.
- Lesions may be found on all body sites, but usually, the mucous membranes are spared.
- Most patients report an increase in number and size of individual lesions with advancing age.
Physical
On physical examination, lesions may have a variable appearance, ranging from a small red macule to a larger dome-topped or polypoid papule.
- The color of the lesions typically is described as bright cherry red, but the lesions may appear more violaceous at times (see Media File 1).
- Rarely, a lesion demonstrates a dark brown to an almost black color when a hemorrhagic plug occupies the vascular lumen, often raising concern about the possibility of a malignant melanoma.
Causes
Little is known about the factors that contribute to the formation of cherry hemangiomas. Several reports have described the appearance of many small red papules histologically resembling cherry hemangiomas in patients with malignancies,1 although most lesions occur in healthy patients.
Angiokeratoma Circumscriptum
Angiokeratoma Corporis Diffusum (Fabry Syndrome)
Angiokeratoma of the Scrotum
Bacillary Angiomatosis
Blue Rubber Bleb Nevus Syndrome
Infantile Hemangioma
Insect Bites
Kaposi Sarcoma
Malignant Melanoma
Milia
Miliaria
Seabather's Eruption
Urticaria, Acute
Other Problems to be Considered
Angiokeratoma of Mibelli
Angiokeratoma of the vulva
Petechiae
Thrombocytopenia or other bleeding disorders (if lesions are numerous and present as small macules)
Lab Studies
- The diagnosis is usually made clinically; however, biopsy allows histopathologic confirmation in doubtful situations.
Procedures
- A skin biopsy (shave or punch) allows histologic confirmation of the diagnosis.
Histologic Findings
On scanning magnification, a sharply circumscribed vascular proliferation usually is noted, often embraced in part by a collarette of epithelium and adnexal structures. Higher magnification demonstrates numerous venules in a thickened papillary dermis. Older lesions often display prominent collagen bundles, which is an appearance suggesting septa.
Medical Care
Medical intervention is not helpful and not indicated in the treatment of the benign vascular proliferations of cherry hemangiomas. Perform biopsy on lesions in which the diagnosis is doubtful. The biopsy procedure may be used as a therapeutic measure to remove traumatized or bleeding lesions.
Surgical Care
Treatment for cherry hemangioma lesions is recommended only in situations of irritation or hemorrhage or in instances in which the lesions are deemed by the patient to be cosmetically undesirable.
- Shave excision: This procedure allows delicate removal of the lesion by blade and histologic confirmation of the diagnosis. Hemostasis following removal may be obtained by chemical means (aluminum chloride) or by performing electrocautery.
- Curettage and electrodesiccation: These techniques permit reliable elimination of the lesion through tissue destruction. The risk of scarring usually is minimal when the technique is performed by a skilled operator.
- Pulsed dye laser: Ablation of lesions using pulsed dye laser may be performed for cosmesis. The use of a pulsed dye laser with a green light source allows selective absorption of the laser energy by the hemoglobin contained within the red blood cells and subsequent obliteration of the vascular lumen.2, 3
- Cryotherapy: Cryotherapy is a less well-controlled means by which lesions are eliminated through irritation, coagulation, and subsequent destruction.
The Medscape Dermatologic Surgery Resource Center may be of interest, as may the eMedicine article Laser Treatment of Benign Pigmented Lesions.
Consultations
Dermatologist consultation may be indicated. For multiple cherry hemangiomas that have appeared over a short period, refer the patient for evaluation to exclude an internal malignancy. In several patients, cherry hemangiomas that have erupted over a very short period of time were associated with an internal malignancy.
Further Outpatient Care
- In general, the benign lesions of cherry hemangioma require no therapy, although lesions that are irritated or bleeding (most commonly secondary to trauma) usually require surgical intervention.
- Follow-up evaluations usually are arranged approximately 1 month after initial therapy.
- Occasionally, more than a single treatment is required to eliminate the lesion(s).
- If the lesions are numerous and present as small macules, consider a bleeding disorder such as thrombocytopenia.
Deterrence/Prevention
- No effective means are available by which the development of the lesions of cherry hemangioma can be prevented.
Complications
- Hemorrhages and secondary infection may complicate the course of traumatized lesions, often requiring surgical removal of the inflamed angioma.
- The gradual appearance of multiple cherry angiomas over many years is common and often is expected; however, the sudden appearance of multiple cutaneous lesions always should raise concerns that the lesions may accompany the development of an internal malignancy.
Prognosis
- The appearance of cherry angiomas has essentially no effect on the patient's life span, except in very rare situations in which the angiomas are present as a paraneoplastic sign in association with the development of an internal malignancy.
Patient Education
- Patients rarely require little more than the reassurance that cherry angiomas are benign lesions and are not skin cancer.
- Occasionally, removal of a lesion that has been traumatized is necessary, or a patient requests removal of lesions because of cosmetic concerns.
Medical/Legal Pitfalls
- Rarely, some confusion may arise in determining whether a deeply violaceous or a darkly pigmented papule represents a traumatized and thrombosed cherry angioma or malignant melanoma. In any situation in which doubt exists regarding the diagnosis of a cutaneous neoplasm, perform a skin biopsy and obtain histopathologic analysis.
| Media file 1:
A large polypoid angioma, deeply red to violaceous cherry, appears in the center of the field. Surrounding the angioma are several small bright red macules and papules that represent cherry hemangiomas in the earlier stages of evolution. |
 |  View Full Size Image | |
Media type: Photo
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- Pembroke AC, Grice K, Levantine AV, Warin AP. Eruptive angiomata in malignant disease. Clin Exp Dermatol. Jun 1978;3(2):147-56. [Medline].
- Dawn G, Gupta G. Comparison of potassium titanyl phosphate vascular laser and hyfrecator in the treatment of vascular spiders and cherry angiomas. Clin Exp Dermatol. Nov 2003;28(6):581-3. [Medline].
- Gupta G, Bilsland D. A prospective study of the impact of laser treatment on vascular lesions. Br J Dermatol. Aug 2000;143(2):356-9. [Medline].
- Calonje E, Wilson-Jones E. Vascular tumors: tumors and tumor-like conditions of blood vessels and lymphatics. In: Elder D, Elenitsas R, Jaworsky C, Johnson B Jr, eds. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:902.
- Hagiwara K, Khaskhely NM, Uezato H, Nonaka S. Mast cell "densities" in vascular proliferations: a preliminary study of pyogenic granuloma, portwine stain, cavernous hemangioma, cherry angioma, Kaposi's sarcoma, and malignant hemangioendothelioma. J Dermatol. Sep 1999;26(9):577-86. [Medline].
- Mazereeuw-Hautier J, Cambon L, Bonafé JL. [Eruptive pseudoangiomatosis in an adult renal transplant recipient]. Ann Dermatol Venereol. Jan 2001;128(1):55-6. [Medline].
- Odom RB, James WD, Berger TB. Dermal and subcutaneous tumors: cherry angiomas. In: Andrew's Diseases of the Skin: Clinical Dermatology. 2000. 9th ed. Philadelphia, Pa: WB Saunders; 2000:751.
- Sanchez JL, Ackerman AB. Vascular proliferations of skin and subcutaneous tissue. In: Fitzpatrick's Dermatology in General Medicine. Vol 1. New York, NY: McGraw-Hill; 1993:1219-20.
Cherry Hemangioma excerpt Article Last Updated: May 9, 2008
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