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Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, December 2017.
Angioma or haemangioma (American spelling ‘hemangioma’) describes a benign vascular skin lesion. An angioma is due to proliferating endothelial cells; these are the cells that line the inside of a blood vessel.
Angiomas can arise in early life (infantile proliferative haemangioma) or later in life; the most common type of angioma is a cherry angioma.
A cherry angioma is a small papular angioma. It is also called a senile angioma but can occur in young people too.
Cherry angiomas are very common in males and females of any age or race. They are more noticeable in white skin than in skin of colour. They markedly increase in number from about the age of 40. There may be a family history of similar lesions. Eruptive cherry angiomas have been rarely reported to be associated with internal malignancy.
Their cause is unknown. Genetic analysis of cherry angiomas has shown that they frequently carry specific somatic missense mutations in the GNAQ and GNA11 (Q209H) genes, which are involved in other vascular and melanocytic proliferations.
Cherry angioma is a firm red, blue or purple papule, 0.1–1 cm in diameter. When thrombosed, they can appear black in colour until evaluated with a dermatoscope when the red or purple colour is more easily seen. Cherry angioma may develop on any part of the body but most often appear on the scalp, face, lips and trunk.
Cherry angiomas are also known as Campbell de Morgan spots.
Cherry angioma is usually easy to diagnose, but occasionally it may be confused with:
Spider telangiectasis, also known as spider naevus, is sometimes (incorrectly) called a spider angioma but this is a vascular dilatation and not a proliferation of endothelial cells.
Cherry angioma is usually diagnosed clinically and no investigations are necessary for the majority of lesions. It has a characteristic red-clod or lobular pattern on dermatoscopy (called lacunar pattern using conventional pattern analysis).
When there is uncertainty about the diagnosis, a biopsy may be performed. The angioma is composed of venules in a thickened papillary dermis. Collagen bundles may be prominent between the lobules. See cherry angioma pathology.
Cherry angiomas are harmless, so do not have to be treated. Occasionally, they are removed to exclude a malignant skin lesion such as nodular melanoma.
Cherry angioma excised to exclude melanoma
If desired for cosmetic reasons, a cherry angioma can be simply removed by one of the following methods:
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