Management of Small Cherry Hemangiomas
For small cherry hemangiomas, observation without intervention is typically recommended as they are benign lesions, but if treatment is desired for cosmetic reasons, laser therapy (particularly pulsed dye laser) is the preferred first-line treatment option due to its efficacy and favorable side effect profile.
Understanding Cherry Hemangiomas
Cherry hemangiomas (also called cherry angiomas or senile hemangiomas) are:
- Benign vascular proliferations of endothelial cells
- Common in adults and typically increase with age
- Usually small, bright red, dome-shaped papules
- Typically asymptomatic and do not require treatment for medical reasons
Treatment Options
Observation
- Appropriate for most small cherry hemangiomas
- No intervention needed if the lesions are not causing symptoms or cosmetic concerns
Laser Therapy
- First-line treatment when intervention is desired for cosmetic reasons 1
- Options include:
- Pulsed dye laser (PDL) - preferred option due to less procedure-related pain
- Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser - produces fewer pigmentary complications
- Potassium-titanyl-phosphate (KTP) laser
- Intense pulsed light (IPL)
Other Treatment Modalities
Sclerotherapy: Using agents like 3% sodium tetradecyl sulfate 2
- Effective alternative when laser therapy is unavailable
- May require multiple sessions (42% respond to single treatment, 44% require second session)
Electrosurgery:
- Electrodessication
- Electrocoagulation
Cryotherapy:
- Simple office procedure
- Risk of hypopigmentation, especially in darker skin types
Radiofrequency ablation:
- Alternative for small lesions
Treatment Selection Considerations
When deciding on treatment, consider:
- Patient preference - cosmetic concerns vs. observation
- Lesion characteristics:
- Size (larger lesions may require multiple treatments)
- Location (visible vs. hidden areas)
- Number of lesions
- Skin type - darker skin types have higher risk of pigmentary changes with PDL and KTP lasers 1
- Available technology - not all practices have access to all treatment modalities
Potential Complications
- Pigmentary changes - hyperpigmentation or hypopigmentation, especially in darker skin types
- Scarring - more common with electrosurgery and cryotherapy
- Incomplete resolution - may require multiple treatments
- Recurrence - possible after any treatment modality
Special Considerations
- Optical coherence tomography can be used to evaluate depth and extent of cherry hemangiomas before treatment, potentially predicting response to laser therapy 3
- Multiple new-onset cherry angiomas in unusual locations or rapid growth may warrant further evaluation to rule out other conditions
Cherry hemangiomas differ from infantile hemangiomas, which have different management approaches and often require more aggressive intervention when they occur in high-risk locations or cause functional impairment.