Cherry angiomas, also referred to as senile angiomas or Campbell de Morgan spots, are among the most common benign vascular skin lesions encountered in adults. Although typically harmless, their appearance can cause cosmetic concern for some individuals, and in rare cases, they may prompt evaluation to rule out systemic associations or other vascular anomalies. This article provides a comprehensive, human-centered exploration of cherry angiomas — discussing their characteristics, causes, clinical significance, differential diagnoses, and management strategies. 

Cherry angiomas represent a benign overgrowth of small blood vessels, creating characteristic red or purple papules that are usually easily recognized on clinical inspection. These lesions are non-cancerous and typically pose no risk to health. While their bright coloration often makes them stand out against the skin, it is important to reassure patients that cherry angiomas are harmless. They do not evolve into malignancy, nor do they typically signal systemic disease. However, in some individuals, especially those with multiple lesions or sudden onset, further evaluation might be warranted to rule out rare associations. 
 
From a histological perspective, cherry angiomas consist of tightly packed clusters of dilated capillaries located within the papillary dermis. These vascular structures are lined by a single layer of flattened endothelial cells. The surrounding stroma is generally unremarkable. Unlike other vascular tumors, cherry angiomas show no evidence of atypia or abnormal mitotic activity, reinforcing their benign nature. 

• Aging: The most significant and well-recognized factor. The incidence of cherry angiomas increases steadily with age, particularly after the age of 30. By the age of 70, most adults will have at least one. 

• Genetic predisposition: Family history appears to play a role in some individuals. People with close relatives who have cherry angiomas may be more likely to develop them, suggesting a genetic influence. 

• Hormonal factors: Although rare, hormonal changes such as those occurring during pregnancy or with hormone replacement therapy may trigger the development of new lesions or increase their number. 

• Chemical exposures: Certain chemicals (for example, bromides and some industrial agents or insecticides) have been linked to the appearance of cherry angiomas in isolated cases, though this is uncommon. 
   

• Possible systemic associations: In very rare situations, a sudden eruption of numerous cherry angiomas (eruptive cherry angiomas) may be associated with internal conditions such as liver disease or, in extremely rare cases, an underlying malignancy. 

Risk factors: 

• Age >30 years 

• Family history of cherry angiomas 

• Exposure to specific environmental agents (rarely) 

1. Appearance and Color: Cherry angiomas appear as small, bright red to deep purple spots or bumps on the skin. The color comes from the collection of tiny blood vessels clustered together, which gives them their distinctive red or purple hue. 

2. Size: These spots are usually very small, often between 1 to 5 millimeters (about the size of a pinhead or a small pea). In some cases, they can grow slightly larger, but they generally remain quite small. 

3. Shape and Texture: Cherry angiomas are typically round or oval in shape. Their surface is usually smooth and can be flat or slightly raised above the surrounding skin. Because they are made of blood vessels, they may feel soft or spongy when touched. 

4. Location on the Body: They most commonly appear on the trunk (chest, back, and abdomen), but can also be found on the arms, shoulders, and sometimes on the legs or other parts of the body. They tend to increase in number with age. 

5. Number and Distribution: Some people have only one or two cherry angiomas, while others may develop many (dozens or even hundreds). They can appear randomly or in clusters. 

6. Symptoms and Sensations: Cherry angiomas are usually painless and do not cause any itching or discomfort. They are generally harmless and do not affect health. 

7. Bleeding and Irritation: Although cherry angiomas rarely cause problems, they may bleed if scratched, rubbed aggressively, or injured. This bleeding is usually minor but can be annoying if frequent. 
8. Changes Over Time: Most cherry angiomas remain stable in size and appearance for years. Occasionally, they may slowly grow larger or increase in number, especially with aging. 

• Clinical Examination: The diagnosis of cherry angiomas is primarily clinical. Dermatologists usually identify them by their characteristic appearance—small, bright red to purple, smooth, dome-shaped papules commonly located on the trunk and limbs of adults. The typical presentation makes diagnosis straightforward in most cases. 

• Dermoscopy: Dermoscopy is a non-invasive tool that helps visualize the lesion more clearly. Under dermoscopy, cherry angiomas show distinct red or reddish-black lacunar (lake-like) structures, corresponding to dilated capillaries within the skin. This helps differentiate them from other vascular lesions or pigmented skin tumors. 

• Histopathology (Biopsy): Biopsy is rarely necessary but may be performed if the lesion looks atypical or if malignancy cannot be ruled out. Microscopically, cherry angiomas reveal clusters of dilated capillaries in the papillary dermis with normal endothelial cells, confirming their benign nature. 

Differential Diagnosis: It’s important to differentiate cherry angiomas from other lesions such as pyogenic granulomas, spider angiomas, amelanotic melanoma, Kaposi sarcoma, and venous lakes, especially if the lesion behaves unusually or shows rapid changes.

Observation (Watchful Waiting) 
Since cherry angiomas are benign and generally asymptomatic, most cases do not require any treatment. Patients are reassured that these lesions pose no health risk and can be left alone unless they cause cosmetic concern or bleeding. 

Indications for Treatment 
Treatment is typically considered when: 

• The angioma bleeds repeatedly or easily after minor trauma. 

• There is significant cosmetic discomfort or psychological distress. 

• The lesion shows suspicious changes requiring removal for diagnosis.  

Treatment Options 

Several effective methods exist to remove cherry angiomas safely: 

• Electrocautery: Uses electrical current to burn and destroy the lesion. It is quick and commonly used, though may cause slight discomfort and minimal scarring. 

• Cryotherapy: Application of liquid nitrogen freezes the lesion, causing it to fall off after a few days. This method is simple and effective but can sometimes cause temporary skin discoloration. 

• Laser Therapy: Pulsed dye laser or Nd:YAG laser targets the blood vessels specifically, destroying the angioma with minimal damage to surrounding tissue. This method offers excellent cosmetic results and low risk of scarring. 

• Shave Excision: Less commonly used, this involves physically removing the lesion with a small surgical blade. It may be reserved for larger or atypical lesions. 

Post-Treatment Care: Following removal, the treated area typically heals well without significant scarring. Patients are advised to protect the skin from trauma and monitor for any signs of recurrence or complications. 

• Recurrence and New Lesions: Removal of individual cherry angiomas does not prevent new ones from developing elsewhere, especially as the person ages. 

The prognosis for cherry angiomas is excellent: 

• No malignant potential. 

• Lesions may increase in number and size with age. 

• Rarely, sudden onset of multiple lesions may warrant investigation for underlying conditions. 

When to Worry? 

 Although cherry angiomas themselves are harmless, a few scenarios merit closer attention: 

• Sudden eruption of numerous angiomas: Could suggest a paraneoplastic phenomenon (very rare). 

• Atypical features: If a lesion shows irregular borders, rapid growth, ulceration, or unusual color changes, consider biopsy to rule out malignancy. 

• Persistent bleeding: If a lesion repeatedly bleeds, removal may be advisable. 

Cherry angiomas are very common, benign vascular skin lesions that typically appear as small, bright red to purple papules, especially in adults over the age of 30. While their exact cause remains unclear, aging and genetic factors play significant roles in their development. These lesions are usually harmless, asymptomatic, and do not require treatment unless for cosmetic reasons or if they bleed frequently. Although generally stable, any sudden increase in number or atypical changes in appearance should prompt medical evaluation to exclude other serious conditions. Effective and minimally invasive treatments like laser therapy or electrocautery are available for those seeking removal. Overall, cherry angiomas have an excellent prognosis with no malignant potential. 

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3. Weedon, D. (2010). Weedon’s Skin Pathology (3rd ed.). Churchill Livingstone. 

4. Wollina, U. (2017). Lesions of skin blood vessels – Clinical and dermoscopic features. Clinical Dermatology Review, 1(2), 33-39.