Cherry angioma, also called cherry hemangioma, is a small

bright red ''Bright Red'' is the fifth studio album by American avant-garde musician Laurie Anderson, released by Warner Bros. in 1994. The album continues the more pop-oriented direction Anderson launched with '' Strange Angels''. Produced by Brian Eno ( ...

dome-shaped

bump Bump or Bumps may refer to: * A collision or impact * A raised protrusion on the skin such as a pimple, goose bump, prayer bump, lie bumps, etc. Infrastructure and industry * Coal mine bump, a seismic jolt occurring within a mine * Bump (u ...

on the skin. It ranges between 0.5 – 6 mm in diameter and usually several are present, typically on the chest and arms, and increasing in number with age. If scratched, they may bleed. They are a harmless benign tumour, containing an abnormal proliferation of blood vessels, and have no relationship to cancer. They are the most common kind of

angioma Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (endothelium) or derived from cells of the tissues surrounding these vessels. Angiomas are a frequent occurrence as patients age, but they might be an indicat ...

, and increase with age, occurring in nearly all adults over 30 years.

Campbell de Morgan Campbell Greig De Morgan (22 November 1811 – 12 April 1876) was a British surgeon who first speculated that cancer arose locally and then spread, first to the lymph nodes and then more widely in the body. His name is used to describe the non c ...

is the nineteenth-century British surgeon who first described them.

Signs and symptoms

Cherry angiomas are made up of clusters of

capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

at the surface of the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

, forming a small round dome ("

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...

"), which may be flat topped . They range in

colour Color (American English) or colour (British English) is the visual perceptual property deriving from the spectrum of light interacting with the photoreceptor cells of the eyes. Color categories and physical specifications of color are associ ...

from bright

red Red is the color at the long wavelength end of the visible spectrum of light, next to orange and opposite violet. It has a dominant wavelength of approximately 625–740 nanometres. It is a primary color in the RGB color model and a secondar ...

purple Purple is any of a variety of colors with hue between red and blue. In the RGB color model used in computer and television screens, purples are produced by mixing red and blue light. In the RYB color model historically used by painters, pu ...

. When they first develop, they may be only a tenth of a millimeter in diameter and almost flat, appearing as small red dots. However, they then usually grow to about one or two millimeters across, and sometimes to a centimeter or more in diameter . As they grow larger, they tend to expand in thickness, and may take on the raised and rounded shape of a

dome A dome () is an architectural element similar to the hollow upper half of a sphere. There is significant overlap with the term cupola, which may also refer to a dome or a structure on top of a dome. The precise definition of a dome has been a m ...

. Multiple adjoining angiomas form a ''polypoid angioma''. Because the

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...

s comprising an angioma are so close to the skin's surface, cherry angiomas may bleed profusely if they are injured. One study found that the majority of capillaries in cherry hemangiomas are

fenestrated A fenestra (fenestration; plural fenestrae or fenestrations) is any small opening or pore, commonly used as a term in the biological sciences. It is the Latin word for "window", and is used in various fields to describe a pore in an anatomical s ...

and stain for carbonic anhydrase activity.

Cause

Cherry angiomas appear spontaneously in many people in middle age but can also, less commonly, occur in young people. They can also occur in an aggressive eruptive manner in any age. The underlying cause for the development of cherry angiomas is not understood. Cherry angioma may occur through two different mechanisms:

angiogenesis Angiogenesis is the physiological process through which new blood vessels form from pre-existing vessels, formed in the earlier stage of vasculogenesis. Angiogenesis continues the growth of the vasculature by processes of sprouting and splitting ...

(the formation of new blood vessels from pre-existing vessels), and

vasculogenesis Vasculogenesis is the process of blood vessel formation, occurring by a '' de novo'' production of endothelial cells. It is sometimes paired with angiogenesis, as the first stage of the formation of the vascular network, closely followed by angio ...

(the formation of totally new vessels, which usually occurs during embryonic and fetal development). One study published in 2010 found that a regulatory nucleic acid suppresses protein growth factors that cause vascular growth. This regulatory nucleic acid was lower in tissue samples of hemangiomas, and the growth factors were elevated, which suggests that the elevated growth factors may cause hemangiomas. The study found that the level of

microRNA MicroRNA (miRNA) are small, single-stranded, non-coding RNA molecules containing 21 to 23 nucleotides. Found in plants, animals and some viruses, miRNAs are involved in RNA silencing and post-transcriptional regulation of gene expression. miRN ...

424 is significantly reduced in senile hemangiomas compared to normal skin resulting in increased protein expression of

MEK1 Dual specificity mitogen-activated protein kinase kinase 1 is an enzyme that in humans is encoded by the ''MAP2K1'' gene. Function The protein encoded by this gene is a member of the dual-specificity protein kinase family that acts as a mito ...

and

cyclin E1 G1/S-specific cyclin-E1 is a protein that in humans is encoded by the ''CCNE1'' gene. Function The protein encoded by this gene belongs to the highly conserved cyclin family, whose members are characterized by a dramatic periodicity in protei ...

. By inhibiting mir-424 in normal

endothelial cells The endothelium is a single layer of squamous endothelial cells that line the interior surface of blood vessels and lymphatic vessels. The endothelium forms an interface between circulating blood or lymph in the lumen and the rest of the vessel ...

they could observe the same increased protein expression of MEK1 and cyclin E1 which, important for the development of senile hemangioma, induced cell proliferation of the

. They also found that targeting MEK1 and cyclin E1 with

small interfering RNA Small interfering RNA (siRNA), sometimes known as short interfering RNA or silencing RNA, is a class of double-stranded RNA at first non-coding RNA molecules, typically 20-24 (normally 21) base pairs in length, similar to miRNA, and operating wi ...

decreased the number of endothelial cells. A study published in 2019 identified that somatic mutations in

GNAQ Guanine nucleotide-binding protein G(q) subunit alpha is a protein that in humans is encoded by the ''GNAQ'' gene. Together with GNA11 (its paralogue), it functions as a Gq alpha subunit. Function Guanine nucleotide-binding proteins are a fam ...

and

GNA11 Guanine nucleotide-binding protein subunit alpha-11 is a protein that in humans is encoded by the ''GNA11'' gene. Together with GNAQ (its paralogue), it functions as a Gq alpha subunit.port-wine stain A port-wine stain (''nevus flammeus'') is a discoloration of the human skin caused by a vascular anomaly (a capillary malformation in the skin). They are so named for their coloration, which is similar in color to port wine, a fortified red wi ...

s and

uveal melanoma Uveal melanoma is a type of eye cancer in the uvea of the eye. It is traditionally classed as originating in the Iris (anatomy), iris, choroid, and ciliary body, but can also be divided into class I (low metastatic risk) and class II (high metasta ...

. As--the mostly juvenile--Waterhouse Friedrichsen Syndrome is caused by adrenal bleeding from bacterial infections, the 'senile' cherry angiomas may have to be researched for a viral and fungal pathology of the adrenals themselves or of the meninges affecting the adrenals with less dramatic bleeding compared to Waterhouse Friedrichsen's. Chemicals and compounds that have been seen to cause cherry angiomas are

mustard gas Mustard gas or sulfur mustard is a chemical compound belonging to a family of cytotoxic and blister agents known as mustard agents. The name ''mustard gas'' is technically incorrect: the substance, when dispersed, is often not actually a gas, b ...

, 2-butoxyethanol,

bromide A bromide ion is the negatively charged form (Br−) of the element bromine, a member of the halogens group on the periodic table. Most bromides are colorless. Bromides have many practical roles, being found in anticonvulsants, flame-retardant ...

s, and

cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...

. A significant increase in the density of

mast cell A mast cell (also known as a mastocyte or a labrocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. Specifically, it is a type of granulocyte derived from the myeloid stem cell that is a par ...

s has been seen in cherry hemangiomas compared with normal skin.

Diagnosis

The diagnosis is based on the clinical appearance of the lesions. Examination with a

dermatoscope Dermatoscopy also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The de ...

shows characteristic red, purple, or blue-black

lagoons A lagoon is a shallow body of water separated from a larger body of water by a narrow landform, such as reefs, barrier islands, barrier peninsulas, or isthmuses. Lagoons are commonly divided into ''coastal lagoons'' (or ''barrier lagoons'') an ...

. The

differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

includes nodular basal cell carcinoma, amelanotic melanoma, and

angiokeratoma Angiokeratoma is a benign cutaneous lesion of capillaries, resulting in small marks of red to blue color and characterized by hyperkeratosis. ''Angiokeratoma corporis diffusum'' refers to Fabry's disease, but this is usually considered a distinct c ...

Treatment

These lesions generally do not require treatment. If they are cosmetically unappealing or are subject to bleeding angiomas may be removed by

electrocautery Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or ...

, a process of destroying the tissue by use of a small probe with an electric current running through it. Removal may cause scarring. More recently

pulsed dye laser A dye laser is a laser that uses an organic dye as the lasing medium, usually as a liquid solution. Compared to gases and most solid state lasing media, a dye can usually be used for a much wider range of wavelengths, often spanning 50 to 100 ...

intense pulsed light Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation (e.g. the treatment of skin pigmentation ...

(IPL) treatment has also been used. Future treatment based on a locally acting inhibitor of

and

Cyclin E1 G1/S-specific cyclin-E1 is a protein that in humans is encoded by the ''CCNE1'' gene. Function The protein encoded by this gene belongs to the highly conserved cyclin family, whose members are characterized by a dramatic periodicity in protei ...

could possibly be an option. A natural MEK1 inhibitor is

myricetin Myricetin is a member of the flavonoid class of polyphenolic compounds, with antioxidant properties. Common dietary sources include vegetables (including tomatoes), fruits (including oranges), nuts, berries, tea, and red wine. Myricetin is structu ...

Prognosis

In most patients, the number and size of cherry angiomas increases with advancing age. They are harmless, having no relation to cancer at all. Eruptive cherry hemangiomatosis, has been rarely reported as a heralding sign of multicentric Castleman disease (MCD), multiple myeloma and other lymphoproliferative diseases.

Epidemiology

Cherry angiomas occur in all races, ethnic backgrounds, and sexes.

References

External links

eMedicine with picture showing small red dots
* {{Vascular diseases Dermal and subcutaneous growths