Cherry Angiomas — PLAB-2 blog
- examiner mla
- Aug 21, 2025
- 3 min read
Updated: Aug 24, 2025
Cherry angiomas (Campbell-de-Morgan spots or Cherry hemangiomas) are common, benign vascular papules. Recognise them, exclude red flags (atypical/ugly-duckling lesion, rapid growth, bleeding, systemic signs), reassure, and only refer/remove if symptomatic, cosmetic or suspicious.
Pathophysiology (what they are)
Benign proliferation of superficial dermal capillaries — histology shows lobules/dilated capillary channels in the papillary dermis.
Clinically small (often 1–5 mm), bright red to purple, dome-shaped papules.
Key clinical features
Multiple, well-defined bright red papules (trunk, chest, back, arms).
Usually asymptomatic; may bleed if traumatised.
Incidence increases with age (most common >30 years).
Risk / predisposing factors
Age (strongest).
Family history / genetics.
Hormonal changes (e.g., pregnancy).
Immunosuppression / systemic disease: occasional associations with eruptive lesions (rare).
Certain chemical exposures / medications: case reports exist (limited evidence).
Trauma to skin may highlight or precede lesions.
Fairer skin may be reported more commonly but occurs in all skin types.
Myths — straight answers
Cancer? No — cherry angiomas are benign.
Caused by sun? No clear link.
Contagious? No.
Will turn into melanoma? No — but any changing/atypical lesion must be assessed.
Is firefighting / fire exposure a risk?
Short answer: No robust evidence links firefighting or fire exposure as a recognised risk factor for cherry angiomas.
Some occupational chemical exposures in case reports have been associated with eruptive vascular lesions, but the data are weak.
Practical approach: if a firefighter (or any worker) presents with a sudden eruption of many lesions or atypical lesions, take an occupational exposure history (chemicals, solvents), review medications and immune status, and refer for dermatology as clinically indicated — not because firefighting is a known cause, but because eruptive/atypical presentations need investigation.
Complications
Bleeding (usually minor; local pressure or cautery controls).
Cosmetic concern.
Rare: eruptive onset with systemic disease — investigate if present.
Not a malignant risk; biopsy only when diagnosis uncertain or lesion suspicious.
Close differential diagnoses & bedside differentiation (concise)
Use history + inspection + diascopy/pressure + comparison to other lesions. Dermoscopy or biopsy if unsure.
Spider naevus (spider angioma)
Central arteriole with radiating legs; blanches and refill from centre on release. Often face/upper chest.
Cherry angioma = round dome papule without radiating legs.
Pyogenic granuloma (lobular capillary haemangioma)
Rapid growth, friable, bleeds easily, often after trauma or in pregnancy.
Cherry angioma = slower, multiple small firm papules; pyogenic granuloma needs excision/biopsy.
Kaposi sarcoma
Purple/brown plaques/nodules, may ulcerate or involve mucosa; associated with immunosuppression/HIV.
If suspected → HIV testing + urgent referral.
Amelanotic / nodular melanoma
Can be pink/red; look for ABCDE (esp. evolution, ulceration, irregular border, different from other lesions).
Any suspicious solitary lesion → urgent (2-week) dermatology/excision.
Angiokeratoma
Dark red/black, keratotic surface; often scrotum/vulva but can be elsewhere.
Venous lake
Soft, compressible, blue-black (lips/face of elderly); compressible vs firm cherry angioma.
Basal cell carcinoma (telangiectatic/pigmented)
Pearly edge, telangiectasia, slow growth; consider excision if suspicious.
Bedside tests: diascopy/pressure (vascular lesions blanch), compare with patient’s other lesions for “ugly duckling”, dermoscopy if available.
Management / treatment (NHS-practical)
Most: no treatment — reassure and safety-net.
Control bleeding: direct pressure; if persistent, urgent clinic/cautery.
Removal (patient choice / symptomatic): cryotherapy, curettage ± cautery, electrosurgery, pulsed dye laser (specialist), sclerotherapy in some centres.
Biopsy / excision: if lesion is atypical or melanoma cannot be excluded — send for histology.
Referral pathways: routine dermatology for cosmetic removal; urgent referral for suspicious lesions (follow local 2-week cancer pathway if melanoma suspected).
Prognosis & natural history (concise)
Overall outlook: Excellent — cherry angiomas are benign with no malignant potential. Patients can be reassured that they are not cancer.
Course over time: Most cherry angiomas persist long-term and commonly remain for life. They may remain stable in size/number for years or slowly increase in number and size with age.
Spontaneous regression: Uncommon in adults. (Do not confuse with infantile haemangiomas, which often involute in childhood — that is a different entity.)
Eruptive onset: When many lesions appear suddenly, they usually persist unless an underlying reversible cause is found and treated — therefore investigate if clinically indicated.
After removal: Individual lesions removed by cryotherapy/curettage/excision usually heal well, but recurrence at the same site is possible and new lesions can appear elsewhere later; removal does not prevent future lesions.
Complications affecting prognosis: Mostly cosmetic concerns or occasional bleeding after trauma. Rare systemic associations (e.g., eruptive lesions in immunosuppressed patients) merit further assessment but do not change the benign histology of typical cherry angiomas.
What to tell patients (one-liner): “These are harmless spots that usually stay but don’t turn into cancer; we only treat them if they bother you or look suspicious.”
📚 References
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