What does a raspberry‑looking lesion on an adult represent and how should it be managed?

Raspberry-Looking Lesion on an Adult

What It Represents

A raspberry-looking lesion on an adult most commonly represents a hemangioma (vascular lesion), though in specific contexts—particularly gastric lesions—it may indicate foveolar-type gastric adenocarcinoma or other neoplastic processes. The term "raspberry-like" describes a characteristic reddish, lobulated appearance with a bumpy surface texture resembling the fruit.

Differential Diagnosis by Location

Cutaneous (Skin) Lesions

When encountered on the skin, dermatoscopy can differentiate a hemangioma from melanocytic lesions such as melanoma, seborrheic keratosis, or pigmented basal-cell carcinoma 1. The key distinguishing features include:

• Hemangiomas: Uniformly reddish, vascular pattern without pigmentation
• Melanoma: Would show asymmetry, irregular borders, heterogeneous color, large diameter (>6mm), and evolution (ABCDE criteria) 1

Gastric Lesions (If Endoscopic Finding)

Recent research has identified raspberry-shaped gastric lesions as a distinct endoscopic finding with multiple potential diagnoses 2:

• Gastric adenocarcinoma of foveolar type (GA-FV): Most common (66% of cases), homogeneously reddish with irregular microvascular pattern 2
• Hyperplastic polyps: Homogeneously reddish with regular microvascular pattern 2
• Neuroendocrine tumors: Rare, regular microvascular pattern, often in patients on long-term acid suppression 3
• PPI-related lesions: Associated with prolonged proton pump inhibitor use 2

All raspberry-shaped gastric lesions exhibit polygonal or curved marginal crypt epithelium on magnifying endoscopy 2.

Management Algorithm

For Cutaneous Lesions:

1. Clinical Assessment: Document size, site, elevation, irregular margins, pigmentation, ulceration, and any changes in size, color, or shape 4

2. If Suspicious for Melanoma (asymmetry, irregular borders, color heterogeneity, diameter >6mm, evolution):

   • Do not remove in primary care 4
   • Urgent referral to dermatology/skin cancer multidisciplinary team 4
   • Complete excisional biopsy with 2mm margin under local anesthetic if melanoma suspected 1
   • Never use laser or electrocautery—only scalpel excision 1

3. If Consistent with Hemangioma:

   • Benign vascular lesion requiring no treatment unless symptomatic or cosmetically concerning
   • Clinical observation is appropriate

For Gastric Lesions (Endoscopic Finding):

1. Endoscopic Characterization:

   • Assess color homogeneity (homogeneous vs. heterogeneous redness)
   • Evaluate microvascular pattern with magnifying narrow-band imaging (regular vs. irregular)
   • Document marginal crypt epithelium pattern 2

2. Biopsy Protocol:

   • Forceps biopsy for initial diagnosis 2, 5
   • If malignancy confirmed: Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for complete histopathological assessment 5, 6

3. Risk Stratification:

   • Irregular microvascular pattern + homogeneous redness = high suspicion for GA-FV 2
   • Regular microvascular pattern = likely benign (hyperplastic polyp or PPI-related) 2
   • History of long-term PPI/vonoprazan use increases risk of neuroendocrine tumor 3

Critical Pitfalls to Avoid

• Never partially biopsy or use destructive techniques (laser, electrocautery) on suspicious pigmented skin lesions—this compromises histological assessment and can lead to misdiagnosis 1
• Do not assume all raspberry lesions are benign—gastric raspberry lesions can harbor adenocarcinoma requiring complete resection 2, 6
• Do not delay referral for changing or atypical lesions—early recognition provides the best opportunity for cure if malignant 4
• Consider immunocompromised status in adults with multiple molluscum-like lesions or unusual presentations 7, 8

Special Considerations

In patients on long-term acid suppression therapy (PPIs, vonoprazan), raspberry-like gastric lesions warrant particular attention as they may represent neuroendocrine tumors or foveolar-type adenocarcinoma that can develop or change rapidly (within 8 months) 5, 3.