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Benign vascular growths including cherry angiomas, treated with laser therapy or electrosurgery when cosmetically desired.
An angioma is a benign vascular growth composed of clusters of blood vessels or lymphatic channels in the skin. The most common type is the cherry angioma (also known as Campbell de Morgan spot or senile angioma), which presents as a small, bright red to dark red, dome-shaped papule on the skin surface. Cherry angiomas are among the most frequently encountered benign skin lesions in adults.
Other types of angiomas include spider angiomas (spider naevi), which feature a central feeding arteriole with radiating capillary branches, and angiokeratomas, which present as small, dark red to purple papules with a rough, keratotic surface. Each type has distinct clinical features, though all are generally benign.
Cherry angiomas are exceedingly common, with an estimated prevalence exceeding 50 percent in adults over the age of 30. Their number typically increases with age, and most individuals develop at least a few over the course of their lifetime.
The precise cause of angiomas is not fully understood. Cherry angiomas are thought to result from the proliferation of endothelial cells lining small blood vessels, though the stimulus for this proliferation remains unclear. Research suggests a role for somatic mutations in certain genes involved in vascular growth signalling.
Factors associated with angioma development include:
The clinical features of angiomas vary depending on the type:
Angiomas are typically diagnosed through clinical examination. Dermoscopy reveals characteristic vascular patterns, including well-demarcated red or red-blue lacunae (lagoons) in cherry angiomas and a central vessel with radiating branches in spider angiomas. These dermoscopic features allow confident diagnosis in most cases.
A biopsy is rarely needed but may be performed when the clinical appearance is atypical or when the lesion must be distinguished from other vascular or pigmented lesions, including melanoma or Kaposi sarcoma.
Angiomas are benign and do not require treatment unless they are cosmetically bothersome, subject to recurrent trauma and bleeding, or diagnostically uncertain. Several effective removal methods are available.
Laser therapy: Vascular lasers, such as pulsed dye laser or Nd:YAG laser, selectively target the haemoglobin within the angioma, causing thermal coagulation and destruction of the vascular lesion with minimal damage to surrounding tissue. This is considered one of the most effective and cosmetically favourable treatment options.
Electrosurgery: Electrodesiccation or electrocautery uses electrical current to coagulate and destroy the vascular lesion. This is a quick, effective method for small cherry angiomas.
Cryotherapy: Liquid nitrogen may be applied to freeze and destroy smaller angiomas. This method is simple and well-tolerated, though post-treatment hypopigmentation is possible.
Shave excision: For larger or raised cherry angiomas, shave excision may be performed under local anaesthesia. This technique provides immediate removal and allows histological examination if needed.
A dermatologist should be consulted when an angioma bleeds repeatedly, changes rapidly in size or colour, or has an atypical appearance that raises concern about other vascular or pigmented lesions. The sudden appearance of numerous spider angiomas may warrant investigation for underlying liver disease. Any vascular lesion with an uncertain diagnosis should be evaluated by a qualified dermatologist to exclude other conditions.
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