What is Cherry Hemangioma (cherry angiomas)?
Cherry hemangiomas are common, harmless skin growths containing tiny blood vessels. They are also referred to as cherry angiomas, adult hemangiomas, or senile angiomas, as they often increase in number with age. These spots were named Campbell De Morgan spots after a surgeon who practiced from 1842 to 1875. Despite having unique clinical and microscopic traits, and occurring widely in adults, cherry hemangiomas are not currently classified as benign vascular tumors by the International Society for Vascular Anomalies (ISSVA).
In different countries, Campbell De Morgan spots have numerous names including senile angiomas, angioma eruption, and ruby spots, among others. Contrary to De Morgan’s belief that these spots were associated with cancer, this is not commonly the case.
According to studies using light and electron microscopes, cherry hemangiomas fall under a category known as papular telangiectasia. Simply put, these growths are made up of new tiny blood vessels, arranged in a certain pattern within the upper layer of skin. Cherry hemangiomas usually appear as many tiny spots, between 1 to 5 mm in size. These bright red, dome-shaped bumps are mostly found on the trunk or upper limbs, and rarely on hands, feet, and face.
What Causes Cherry Hemangioma (cherry angiomas)?
Cherry angiomas are small, red skin growths that have several potential causes, although the exact cause is not certain. Here are some possibilities.
The first thought is aging. These skin changes are often seen in older individuals, suggesting that the aging process may contribute to their development.
Secondly, they might be tied to changes in our genes. Certain specific changes, called somatic missense mutations, in genes known as GNAQ and GNA11 have been found in these skin changes.
Another possibility is pregnancy. It’s not uncommon for these red spots to appear during pregnancy.
There’s a term known as “eruptive cherry angiomas”. This refers to a sudden appearance of many cherry angiomas all at once. This could happen because of a few things:
First, a medication used to treat skin discoloration known as vitiligo, topical nitrogen mustard, can sometimes cause them.
Secondly, a drug called cyclosporine, often used to prevent rejection after an organ transplant, might result in these skin changes.
Thirdly, a condition known as chronic graft-host disease, which can occur after a transplant, might lead to this problem.
These red skin spots can also be seen in conditions that affect the immune system, such as multicentric Castleman disease (MCD) and other disorders known as lymphoproliferative diseases. The theory is that high levels of a protein called interleukin 6 might cause the body to produce more of something called vascular endothelial growth factor. So, if you suddenly have a lot of cherry angiomas along with other symptoms like swelling in your lymph nodes, it might be a good idea to get tested for these conditions.
A medication called ramucirumab might also cause cherry angiomas. This is thought to be due to this drug’s effect on something called VEGFR2 mutation.
Finally, a common virus known as human herpesvirus-8 has been found in many cases of eruptive cherry hemangiomas.
Risk Factors and Frequency for Cherry Hemangioma (cherry angiomas)
Cherry hemangiomas are small red spots that appear on the skin, found in around 7% of teenagers and 75% of people over the age of 75. They usually develop when people are in their 30s or 40s but can start to appear as early as the 20s in 5% to 41% of people.
- These spots start off small, about 1mm in size.
- They can grow to be up to 2.3mm by the time a person reaches 50 years old.
- However, they generally stay smaller than 3.5 mm.
Cherry hemangiomas are seen in all races and ethnicities in equal numbers and are not more common in one gender over another.
Signs and Symptoms of Cherry Hemangioma (cherry angiomas)
Cherry hemangiomas are small, bright red bumps on the skin. These are often dome-shaped and surrounded by a pale circle. The size typically ranges from 1 to 5 millimeters. They are clearly defined and often have dividing walls known as septa. Most commonly, many of these bumps can be found on the trunk or the upper part of the limbs. On the other hand, they are rare on the face, hands, and feet. When several angiomas join together, they can form a larger bump called a polypoid angioma. Applying pressure on these bumps may cause them to lighten in color, but some are fibrous and may not change color completely.
These bumps are a common type of skin changes seen with age and have no chances of turning into cancer. They can be identified by their appearance alone. However, they can sometimes be mistaken for a type of skin cancer called amelanotic melanoma, which is more prone to bleeding.
Testing for Cherry Hemangioma (cherry angiomas)
Cherry hemangiomas, small bright red growths on the skin, are typically identified by their appearance. Before treatment, such as laser therapy, a type of scanning called optical coherence tomography may be used. This type of scan uses low energy light to create an image of the hemangioma, helping doctors understand its size and depth. This is useful for predicting how the hemangioma will respond to the laser therapy. If there’s a concern that the growth could be cancerous, it may be removed and sent for further testing.
Under the microscope, cherry hemangiomas look similar to another type of blood vessel growth called capillary hemangiomas. They are made up of many new, tiny, balloon-like blood vessels with thin, narrow openings and highlighted lining cells. These cells tend to be clustered together in a lobular, or rounded, pattern in the upper layer of the skin. Initially, new blood vessels are formed, which later widen or dilate. This means that older hemangiomas often have larger blood vessels.
Moreover, the tissue fibers between these blood vessels may appear uniform and show signs of fluid buildup. The overlying skin may thin out, characterized by a loss of skin texture. In some cases, it may resemble a type of skin growth called a pyogenic granuloma. Also, a special type of staining technique that highlights particular proteins doesn’t show any abnormal protein expressions in these hemangiomas. The enlarged and filled blood vessels might contribute to the bright red color of cherry hemangiomas. The thin overlying skin and the lesion’s closeness to the skin surface may make these hemangiomas bleed easily if injured.
Treatment Options for Cherry Hemangioma (cherry angiomas)
Cherry hemangiomas are skin growths that can often be ignored unless they are physically injured and start to bleed. Most people seek to remove these growths for aesthetic reasons or to prevent bleeding from accidental bumping or scratching.
There are a variety of methods to get rid of these growths, depending mainly on their size. For small ones, doctors typically numb the area using a local anesthetic and then use a medical technique called electrocauterization, which involves burning the growth with electricity.
For larger growths, they may use a method called shave excision. This method involves shaving off the growth and then using the electric burn technique on the base to prevent its return. Another technique, cryotherapy, might be applied, which involves freezing off the growth.
Superficial growths, which are closer to the surface of the skin, can be removed using a specific type of laser therapy termed as CO2 laser therapy.
While cold therapy (cryosurgery), electric burn (electrosurgery), or scrape and remove (curettage) methods have traditionally been used, new methods using specialized lasers (pulsed dye laser, intense pulsed light) or Krypton and 532 nm diode lasers showing promising results. They efficiently destroy these growths.
However, one thing to remember is that the removal of these Cherry hemangiomas could potentially result in minor scarring. This is something one should discuss with their doctor before choosing a treatment option.
What else can Cherry Hemangioma (cherry angiomas) be?
In simple terms, when a skin condition looks like a cherry hemangioma, medical professionals consider several other possibilities before finalizing a diagnosis. These could be:
- A skin cancer called amelanotic melanoma
- Lobular capillary hemangioma, a type of skin tumor
- Pyogenic granuloma, an overgrowth of tissue due to irritation
- Acquired tufted hemangioma, a benign skin growth usually present at birth
- Glomeruloid hemangioma, a rare type of hemangioma
- Targetoid hemosiderotic hemangioma, a type of blood vessel growth with surrounding bruise-like discoloration
- Angiolymphoid hyperplasia with eosinophilia, a benign skin condition involving inflamed blood vessels
- Spindle cell hemangioma, another benign blood vessel growth
It’s important to remember that appearance alone cannot conclusively diagnose these conditions, and further tests may be necessary.
What to expect with Cherry Hemangioma (cherry angiomas)
The outlook for most patients is very good. These sores or wounds, also known as lesions, often don’t show any symptoms.
Possible Complications When Diagnosed with Cherry Hemangioma (cherry angiomas)
These spots can bleed if they’re bumped or scratched. People might want to remove a cherry hemangioma for looks or to prevent bleeding if it’s in a spot where it might get injured. However, it’s critical to inform anyone considering removal that it could leave a scar.
Things to Note:
- Cherry hemangiomas can bleed when injured
- People often remove these for aesthetics or to prevent injury-related bleeding
- Removing these spots could cause scarring
Preventing Cherry Hemangioma (cherry angiomas)
Cherry hemangiomas, small, bright red growths on the skin, have been often linked with certain chemicals. For this reason, people are advised to avoid using chemicals like nitrogen mustard, bromides, and other similar substances typically found in tropical climates on their skin. It’s also been observed that these growths are usually larger in people with diabetes and they tend to grow more quickly in warmer climates.
These skin growths have also been found in people who have undergone a liver transplant, those with a condition called graft versus host disease, and in people who are immunocompromised (with weakened immune systems) due to treatment with a drug called cyclosporine. Cherry hemangiomas have also been seen in individuals with cerebral cavernous malformations, a brain condition that affects blood vessels. Furthermore, there has been a reported case of a family member with early-onset cherry hemangiomas and a skin condition called nevus flammeus.
Cherry hemangiomas are more commonly found in middle-aged to older adults, and their numbers tend to increase with age. These skin growths often start appearing after the age of 30. They are found in only 5% of teenagers, but 75% of adults over 75 years of age. In nursing homes, instances of multiple cherry hemangiomas have been reported, and these seem to be strongly linked with infections.