Cherry Hemangioma

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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.

Epidemiology

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 the image below).


View Image

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.

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.

Laboratory Studies

The diagnosis of cherry hemangioma 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. Options include the following:

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.

Diet

The occurrence of cherry angiomas has never been demonstrated to have any relationship to diet.

Activity

The occurrence of cherry angiomas has never been shown to be related to the level of physical activity.

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.

Author

Clarence William Brown Jr, MD, Assistant Professor of Dermatology, Dermatologic and Mohs Micrographic Surgery, Rush University Medical Center

Disclosure: Nothing to disclose.

Specialty Editors

Evan R Farmer, MD, Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Disclosure: Nothing to disclose.

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Disclosure: Nothing to disclose.

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York

Disclosure: Nothing to disclose.

References

  1. Pembroke AC, Grice K, Levantine AV, Warin AP. Eruptive angiomata in malignant disease. Clin Exp Dermatol. Jun 1978;3(2):147-56. [View Abstract]
  2. 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. [View Abstract]
  3. 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. [View Abstract]
  4. Bernstein EF. The pulsed-dye laser for treatment of cutaneous conditions. G Ital Dermatol Venereol. Oct 2009;144(5):557-72. [View Abstract]
  5. Ma HJ, Zhao G, Shi F, Wang YX. Eruptive cherry angiomas associated with vitiligo: provoked by topical nitrogen mustard?. J Dermatol. Dec 2006;33(12):877-9. [View Abstract]
  6. 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.
  7. 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. [View Abstract]
  8. Mazereeuw-Hautier J, Cambon L, Bonafe JL. [Eruptive pseudoangiomatosis in an adult renal transplant recipient]. Ann Dermatol Venereol. Jan 2001;128(1):55-6. [View Abstract]
  9. 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.
  10. 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.

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.

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.