What is the clinical significance of multiple cherry angiomas (hemangiomas)?

From the Guidelines

Cherry hemangiomas are generally benign and have no significant medical implications when they appear in widespread distribution. These small, bright red skin growths are extremely common, affecting up to 75% of people over age 30, and tend to increase in number with age. While the sudden appearance of multiple cherry hemangiomas might concern patients, this pattern typically represents a normal aging process rather than indicating an underlying disease. No treatment is necessary unless they cause cosmetic concerns or become irritated from friction. In rare cases, a sudden eruption of numerous cherry hemangiomas may be associated with pregnancy, certain medications, or exposure to chemicals like bromides, but these associations are uncommon. If a patient notices a dramatic increase in cherry hemangiomas over a short period, a dermatology consultation may be warranted to rule out other conditions, though this is primarily precautionary. The exact cause of cherry hemangiomas involves localized proliferation of blood vessels, possibly related to vascular growth factors that increase with age.

Key Considerations

• The provided evidence primarily discusses infantile hemangiomas, which are distinct from cherry hemangiomas in terms of their presentation, behavior, and management 1.
• Infantile hemangiomas can have significant implications, including the risk of complications such as ulceration, bleeding, and high-output cardiac failure, especially in the case of hepatic hemangiomas 1.
• However, cherry hemangiomas are generally not associated with such risks and are considered benign.
• The most recent and highest quality study relevant to the management of hemangiomas is the 2019 clinical practice guideline for the management of infantile hemangiomas 1, but it does not directly address cherry hemangiomas.

Management Approach

• Given the benign nature of cherry hemangiomas, no treatment is typically necessary unless they cause cosmetic concerns or become irritated.
• In cases where cherry hemangiomas are numerous or appear suddenly, a precautionary approach may include a dermatology consultation to rule out other conditions.
• The focus should be on reassuring patients about the benign nature of these lesions and addressing any cosmetic concerns they may have.

From the Research

Widespread Cherry Hemangiomas Significance

• Cherry angiomas, also known as cherry hemangiomas, are benign vascular proliferations of endothelial cells associated with aging 2.
• They are the most common vascular tumors of the skin and become more common with age 3.
• Although previously considered to have no clinical relevance other than their association with age, recent studies have shown a link between cherry angiomas and exposure to various toxic substances and medications, benign and malignant diseases, and immunosuppression 3.
• Treatment modalities for cherry angiomas include laser therapy and non-laser therapy, with pulsed dye laser (PDL) being a preferred option due to decreased procedure-related pain 2.
• Other treatment options include potassium-titanyl-phosphate (KTP) laser, electrodessication, cryotherapy, sclerotherapy, and radiofrequency ablation, with no single therapy proving to be superior 2, 4.
• Complications following PDL treatment of superficial hemangiomas can occur, including severe ulceration, scarring, and life-threatening hemorrhage 5.
• The clinical relevance of cherry angiomas is still being studied, with recent research providing clues for a better understanding of their etiology, pathophysiology, and clinical relevance 3.
• Comparison of different treatments has shown that laser therapy, especially PDL, may minimize the likelihood of treatment-associated textural change 4.