Cherry hemangiomas are the most common cutaneous vascular proliferations. They are often widespread and appear as tiny cherry red papules or macules.
Involvement of cherry hemangiomas is limited to the skin. These benign lesions are formed by a proliferation of dilated venules.
Frequency of cherry hemangiomas increases with age in both sexes and all races.
The incidence of cherry angiomas is uniform across all races, but individual lesions are most noticeable in pale-skinned individuals.
Lesions are benign and usually do not undergo spontaneous involution. Patients may demonstrate considerable concern regarding the cosmetic appearance of the lesions.
Cherry hemangiomas are found in individuals of all races and ethnic backgrounds.
No distinction can be made on the basis of sex.
Cherry hemangiomas occur more frequently with increasing age. In the past, the lesions often were referred to as senile angiomas.
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.
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 the image below).
A large polypoid angioma, deeply red to violaceous cherry, appears in the center of the field. Surrounding the angioma are several small bright red ma....
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.
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, although most lesions occur in healthy patients.
The diagnosis of cherry hemangioma is usually made clinically; however, biopsy allows histopathologic confirmation in doubtful situations.
A skin biopsy (shave or punch) allows histologic confirmation of the diagnosis.
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 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.
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. Options include the following:
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.
The occurrence of cherry angiomas has never been demonstrated to have any relationship to diet.
The occurrence of cherry angiomas has never been shown to be related to the level of physical activity.
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.
No effective means are available by which the development of the lesions of cherry hemangioma can be prevented.
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.
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.