Cherry angioma (Cherry hemangioma, Senile Angioma, Campbell-De Morgan spot)

Are You Confident of the Diagnosis?

Characteristic findings on physical examination

Cherry angiomas are the most common acquired cutaneous vascular anomaly. They are round to oval, dome–shaped papules ranging in size from pin point to several millimeters. Cherry angiomas are found mainly on the trunk and proximal extremities (Figure 1); however, they can be found anywhere on the body, except glaborous skin. Cherry angiomas are usually bright cherry red in color but can become thrombosed and become black. They are generally asymptomatic but may bleed if traumatized. The differential diagnosis of cherry angiomas includes melanoma, petechiae, and glomeruloid hemangiomas.

Expected results of diagnostic studies

Clinically these lesions are usually easily distinguishable; however, if biopsied the lesions show a proliferation of congested, ectatic capillaries, and post capillary venules in the papillary dermis with a scant edematous or fibrotic stroma (Figure 2). There may be loss of the rete ridges centrally with peripherally displaced adnexal epithelial collarettes. By reflectance confocal microscopy a greater number, tortuosity, and dilatation of dermal capillaries vessels are seen with thin fibrous septae in a lobular arrangement and a flow velocity of medium.

Cherry angioma. Low Power. (Courtesy of Bryan Anderson, MD)

Diagnosis confirmation

Patients that have POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopahthy and skin lesions) acquire many cherry angiomas, but also develop glomeruloid hemangiomas that may initially only be able to be distinguished by histology.

Who is at Risk for Developing this Disease?

These lesions occur equally in both sexes and all ethnicities, but are more common in Caucasians. Most Caucasians obtain a few cherry angioma by their 30s to 40s, the number of lesions increase over time. Some elderly patients may have hundreds of these lesions.

What is the Cause of the Disease?

Pathophysiology

The etiology of these lesions are unknown; however, increased number of lesions have been reported during pregnancy and eruptive cherry hemangiomas have also been reported with increased levels of prolactin, both signifying a possible hormonal factor in pathogenesis.

Systemic Implications and Complications

There are no associated systemic disorders associated with cherry hemangiomas. However, if a young patient developed eruptive or hundreds of lesions, referral to an endocrinologist to rule out hormonal disorders or to a neurologist to rule out familial cerebral cavernous malformations may be warranted.

Treatment Options

Treatment options are summarized in Table I.

Table I.

Medical Treatment	Surgical Procedures	Physical Modalities
	Shave excision
	Electrodessication
	Laser Ablation: Nd:Yag, PDL, IPL, or KTP lasers

Optimal Therapeutic Approach for this Disease

Cherry angiomas seldom become irritated, but patients may request cosmetic removal. Physical modalities include shave excision and electrodessication, and laser ablation may be performed. However, risk of scarring must be discussed.

Patient Management

Cherry angiomas seldomly become irritated, but patients may request cosmetic removal. Physical modalities include shave excision, and electrodessication, and laser ablation may be performed. However, risk of scarring be discussed.

Unusual Clinical Scenarios to Consider in Patient Management

Remember that although these lesions are extremely common, if a younger patient has hundreds of lesions familial cerebral cavernous malformations may be considered. These lesions may be more blue in color than the typical red of cherry angiomas. When these lesions are surrounded by a purpuric halo, amyloidosis should be considered.

There has been a case report of eruptive cherry angiomas in a young patient after use of nitrogen mustard cream for vitiligo.

What is the Evidence?

Astner , S, Gonzalez , S, Cuevas , J, Rowert-Huber , J, Sterry , W, Stockfleth , E, Ulrich , M. “Preliminary evaluation of benign vascular lesions using in vivo reflectance confocal microscopy”. Dermatol Surg . vol. 36. 2010. pp. 1099-110. (A descriptive evaluation of different vascular lesions using reflectance confocal microscopy (RCM), a novel noninvasive imaging technique for in vivo evaluation of cutaneous lesions at near-histologic resolution.)

Clatterbuck , RE, Rigamonit , D. “Cherry angiomas associated with familial cerebral cavernous malformations. Case illustration”. J Neurosurg. vol. 96. 2002. pp. 964(A case presentation of a 51-year-old male and his mother with over 100 cherry angiomas each and the finding of multiple cavernous malformations.)

Schmidt , CP. “Purpuric halos around hemangiomas in systemic amyloidosis”. Cutis. vol. 48. 1991. pp. 141-3. (A patient with systemic amyloidosis noted purpuric halos around cherry hemangiomas. This was also reported in one other case.)

Ma , HJ, Zhao , G, Shi , F, Wang , YX. “Eruptive cherry angiomas associated with vitiligo: provoked by topical nitrogen mustard?”. J Dermatol . vol. 33. 2006. pp. 877-9. (A 27-year-old male who developed several biopsy-proven cherry angiomas on the area treated with topical nitrogen mustard for vitiligo.) .

Bernstein , EF. “The pulsed-dye laser for treatment of cutaneous conditions”. G Ital Dermatol Venereol. vol. 144. 2009 Oct. pp. 557-72. (A review of the multiple uses and outcomes of PDL laser for skin lesions, including cherry angiomas.)

Fodor , L, Ramon , Y, Fodor , A, Carmi , N, Peled , IJ, Ullmann , Y. “A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions”. Ann Plast Surg. vol. 56. 2006 Feb. pp. 164-70. (This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions including cherry angiomas.)

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. vol. 28. 2003 Nov. pp. 581-3. (This open study assesses the efficacy of two treatment modalities, scoring patients' preference and psychological morbidity before and after treatment.)

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