Cherry angiomas: what they are, causes and whether they need treatment

The Primary Care Dermatology Society (PCDS) describes an angioma as a benign, acquired vascular proliferation of the skin: a harmless overgrowth of small blood vessels that appears after birth. The term cherry angioma is used for angiomas with a cherry-like (or blackberry-like) appearance, and the term Campbell de Morgan spots is sometimes used when there are numerous small angiomas.

Its patient leaflet says angiomas are common and non-cancerous, and that the cherry angioma is the most common type.

Based on the PCDS leaflet and clinical guidance, cherry angiomas usually have the following features.

• They are often multiple, and the number increases with age, from about the age of 40.

• They can develop on any part of the body but are most common on the trunk.

• Cherry angiomas are bright red; other angiomas can be blue and/or purple.

• They are raised and smooth to the touch, soft papules or nodules that are partially compressible.

• They are usually less than 1 cm in diameter.

• They are usually painless. The surrounding skin is usually normal unless the angioma has bled into it.

PCDS says the cause is not known. What the guidance does make clear is that they are acquired, meaning they are not usually present at birth, and that their number increases with age.

The PCDS leaflet gives no way of preventing them.

PCDS clinical guidance says cherry angiomas are usually without symptoms, but that surface bleeding, or bleeding into the surrounding skin, can occur if they are traumatised, including at sites of friction. A lesion can also thrombose (form a small clot), suddenly turning black. PCDS describes a thrombosed angioma as a long-term lesion that suddenly went black.

A sudden colour change can be alarming, which is one reason to have a changing spot checked. A soft, compressible lesion that is red-purple, or black because of thrombosis, is typical of an angioma, whereas the PCDS guidance lists features of concern when a lesion is being assessed for melanoma: sustained growth, firmness, not being compressible, multiple colours including brown, and individual blood vessels running over the lesion.

Doctors may use a dermatoscope (a handheld magnifier) to look at the spot. PCDS describes multiple well-separated red lacunae (small compartments) as the typical pattern of a cherry angioma.

The PCDS leaflet says most angiomas do not need treatment, and that the only reasons for contacting your GP surgery are if an angioma catches and bleeds on a regular basis, in which case treatment may be offered, or if you develop a skin lesion that looks different to the others, which it calls an "ugly duckling".

The clinical guidance also lists scale on a lesion as pointing towards a different diagnosis, an angiokeratoma, so a lesion that looks different to your other spots is worth showing to a clinician. Any new, changing or unusual-looking skin lesion should be checked, even if you have many cherry angiomas.

PCDS says most angiomas do not need treatment. Those that catch and bleed repeatedly may be treated by scraping off (curettage) using local anaesthetic, and the clinical guidance says a lesion removed this way can be sent for histology (laboratory examination).

The leaflet says angiomas cannot be treated on the NHS for cosmetic reasons. If you choose to have them treated privately, laser is another option. If you are considering private removal, ask who will examine the lesion beforehand and whether any removed tissue will be sent for laboratory testing.

Several skin lesions can look similar at a glance. PCDS notes that a scaly red or purple lesion is more likely an angiokeratoma. Melanoma is a possible differential diagnosis when a lesion has brown or other atypical colour, or blood vessels running through it. Other common benign lesions are covered on our pages about moles, skin tags and seborrhoeic keratosis.

If you cannot tell, a GP or a dermatologist can examine the spot.

Your GP can assess a changing, bleeding or unusual spot and arrange treatment or referral if that is needed. NHS treatment is usually limited to lesions that bleed repeatedly or where there is diagnostic uncertainty. Cosmetic removal is not provided on the NHS, so people who want it done choose a private dermatology or skin clinic, where laser is one of the options. A diagnosis should be confirmed by a clinician before any removal.