Is cherry angioma related to chemotherapy (chemo) exposure?

Cherry Angiomas and Chemotherapy Exposure: No Direct Relationship Established

There is no established direct relationship between cherry angiomas and chemotherapy exposure based on current medical evidence. While chemotherapy is associated with various cutaneous side effects, cherry angiomas have not been specifically linked to chemotherapy in the medical literature.

What Are Cherry Angiomas?

Cherry angiomas (also called senile hemangiomas or Campbell de Morgan spots) are:

• Benign vascular proliferations of endothelial cells
• The most common vascular tumors of the skin
• Typically appear as round-to-oval, bright red, dome-shaped papules measuring up to several millimeters
• Histologically characterized by numerous newly developed capillaries with narrow lumens and prominent endothelial cells in the papillary dermis 1

Known Associations with Cherry Angiomas

Cherry angiomas are primarily associated with:

1. Age: They become more common with advancing age 2
2. Toxic substance exposure: Recent studies have shown links between cherry angiomas and exposure to various toxic substances 2
3. Bromide exposure: Laboratory technicians exposed to brominated compounds have developed multiple cherry angiomas 3
4. Certain medications: Some medications have been associated with cherry angiomas 2
5. Immunosuppression: There are associations with immunosuppressed states 2

Chemotherapy and Skin Manifestations

While chemotherapy is known to cause various cutaneous side effects, the available evidence does not specifically identify cherry angiomas as a direct consequence of chemotherapy exposure. The guidelines on cancer treatment and chemotherapy side effects do not mention cherry angiomas as a recognized manifestation 4.

Chemotherapy is associated with:

• Angiogenesis alterations: Chemotherapy can influence tumor angiogenesis, which is critical to the growth of solid tumors 4
• Vascular damage: Many cancer therapies can induce vascular damage directly or indirectly 4
• Antiangiogenic effects: Some agents like thalidomide, lenalidomide, and bevacizumab specifically target angiogenesis 4

Potential Mechanisms for Vascular Proliferations

In rare cases, vascular proliferations have been associated with certain conditions that might involve similar pathways as those affected by chemotherapy:

• Eruptive cherry hemangiomatosis has been reported as a heralding sign of multicentric Castleman disease and other lymphoproliferative diseases, possibly due to hypersecretion of vascular endothelial growth factor secondary to elevated interleukin-6 levels 5
• Antiangiogenic agents used in cancer treatment work by inhibiting pathways that could theoretically affect the development of vascular lesions 4

Clinical Implications

For patients concerned about cherry angiomas appearing during or after chemotherapy:

1. Document the timing and pattern of appearance
2. Consider other potential causes or associations
3. Remember that cherry angiomas are extremely common benign lesions in the general population
4. Treatment is generally not necessary unless desired for cosmetic reasons

If treatment is desired for cosmetic purposes, options include:

• Laser therapies (pulsed dye laser, Nd:YAG, KTP)
• Non-laser therapies (cryotherapy, sclerotherapy, electrosurgery) 6

Conclusion

While cherry angiomas have been associated with various exposures and conditions, there is no established direct relationship with chemotherapy in the current medical literature. The appearance of cherry angiomas during or after chemotherapy treatment is more likely coincidental or related to other factors such as age or other medication exposures.