Cherry Angiomas: What Those Small Red Spots on Your Skin Actually Are

What is a cherry angioma?

A cherry angioma (also called a senile angioma, cherry hemangioma, or Campbell de Morgan spot) is a benign overgrowth of small blood vessels in the upper layers of the skin. Under a microscope, the lesions consist of newly formed capillaries with narrow lumens and prominent endothelial cells arranged in a lobular pattern in the papillary dermis 1Ref 1Satter EK, Elston DM (2024).Cherry Hemangioma.Prevalence (7% of adolescents; ~75% of adults over 75); classification as most common acquired vascular proliferation; histological description; treatment options.

They appear as round or oval spots — vivid cherry-red to dark red or purple — typically 1 to 5 millimeters across. The surface is smooth and the shape is flat or slightly dome-shaped. Most people begin to notice them in their 30s or 40s, and the number tends to increase steadily with age. They occur across all races, ethnicities, and sexes.

The most common locations are the trunk (chest, abdomen, back) and proximal limbs. They appear less often on the face, hands, and feet.

How common are cherry angiomas?

Cherry angiomas are the most common type of acquired vascular proliferation of the skin 1Ref 1Satter EK, Elston DM (2024).Cherry Hemangioma.Prevalence (7% of adolescents; ~75% of adults over 75); classification as most common acquired vascular proliferation; histological description; treatment options. They are found in roughly 7% of adolescents, but prevalence rises sharply with age, reaching approximately 75% of adults over 75 years old 1Ref 1Satter EK, Elston DM (2024).Cherry Hemangioma.Prevalence (7% of adolescents; ~75% of adults over 75); classification as most common acquired vascular proliferation; histological description; treatment options.

A body-imaging study of 163 adults found that the trunk — both front and back — accounts for the largest concentration of lesions, and that age and male sex correlated with higher lesion counts overall, while women tended to have more lesions on the legs 2Ref 2Betz-Stablein B, Koh U, Edwards HA, McInerney-Leo A, Janda M, Soyer HP (2022).Anatomic Distribution of Cherry Angiomas in the General Population.Body distribution of cherry angiomas; trunk predominance; sex and age correlations. Because cherry angiomas are so common and so consistently benign, they often go unreported and uncounted in routine care.

Why do cherry angiomas develop?

The precise cause of cherry angiomas is not fully established. Several factors appear to contribute:

Age is the clearest and most consistent driver. The accumulation of lesions over decades points to age-related changes in vascular regulation and endothelial biology.

Somatic genetic mutations have been identified in a subset of lesions. A targeted next-generation sequencing study found activating missense mutations in the *GNAQ* and *GNA11* genes — specifically variants Q209H, Q209R, and R183G — in 50% of cherry angioma samples tested 3Ref 3Klebanov N, Lin WM, Artomov M, Shaughnessy M, Njauw CN, Bloom R, Eterovic AK, Chen K, Kim TB, Tsao SS, Tsao H (2019).Use of Targeted Next-Generation Sequencing to Identify Activating Hot Spot Mutations in Cherry Angiomas.GNAQ and GNA11 somatic mutations found in 50% of cherry angioma samples; supports clonal vascular proliferation model. These mutations affect G-protein signaling and suggest that at least some cherry angiomas represent clonal vascular proliferations rather than simple degenerative changes.

Endothelial proliferation is a histological hallmark. A study examining 23 cherry angiomas using Ki67 and Wilms tumor protein 1 (WT1) markers found evidence of active endothelial proliferation in all lesions, with proliferation rates ranging from below 0.5% to 3.59% 4Ref 4Fernandez-Flores A, Colmenero I (2018).Campbell de Morgan Spots (Cherry Angiomas) Show Endothelial Proliferation.Evidence of active endothelial proliferation (Ki67, WT1) in all cherry angiomas studied; supports benign tumor classification. This supports their classification as benign vascular tumors rather than purely degenerative spots.

Hormonal and other factors have been proposed — new lesions sometimes appear during pregnancy, and some observational data link them to hormonal changes — but the evidence is limited and no definitive causal mechanism has been established. Tamsulosin use was identified as an independent risk factor in one case-control study, while clopidogrel appeared protective 5Ref 5Nazer RI, Bashihab RH, Al-Madani WH, Omair AA, AlJasser MI (2020).Cherry angioma: A case-control study.Tamsulosin as independent risk factor; clopidogrel as protective factor in case-control study of 300 participants.

Cherry angiomas are not caused by sun exposure and are not contagious.

Do cherry angiomas need treatment?

No treatment is medically necessary. Cherry angiomas are benign, do not progress to cancer, and do not spread. Many people choose removal for cosmetic reasons or because a lesion sits in a location where it bleeds easily from friction with clothing.

A systematic review of the available evidence identified multiple effective removal options 6Ref 6Buslach N, Foulad DP, Saedi N, Mesinkovska NA (2020).Treatment Modalities for Cherry Angiomas: A Systematic Review.Systematic review of treatment options; PDL preferred for pain reduction; Nd:YAG advantageous for darker skin; multiple effective modalities identified:

• Pulsed-dye laser (PDL) — generally preferred for its lower procedure-related pain and lower risk of textural change compared to other methods.
• Potassium titanyl phosphate (KTP) laser — effective, though typically associated with more discomfort than PDL.
• Nd:YAG laser (1064 nm) — produces fewer pigmentary complications and may be better suited for darker skin tones.
• Electrodesiccation / electrosurgery — effective for lesion color but may produce greater textural change than laser options 7Ref 7Collyer J, et al. (2010).Comparison of treatment of cherry angiomata with pulsed-dye laser, potassium titanyl phosphate laser, and electrodesiccation: a randomized controlled trial.RCT showing electrodesiccation produces significantly greater textural change than PDL or KTP laser; all treatments effective for color improvement.
• Cryotherapy — an alternative; patient and physician satisfaction tends to be higher with electrosurgery than cryotherapy for this lesion type.
• Shave excision — infrequently used; may be considered when tissue is needed for histology.

All removal procedures are elective and are typically considered cosmetic by insurers. A dermatologist can advise on which method suits a given lesion's size, location, and the patient's skin type. Removal carries a small risk of scarring regardless of technique.

How is a cherry angioma told apart from other red spots?

The classic cherry angioma is uniform in color, smooth-surfaced, stable over time, and blanches with pressure (turns white when pressed). A few other lesions can look similar:

Petechiae and purpura — flat, pinpoint spots that do not blanch when pressed. Unlike cherry angiomas, petechiae appear suddenly, often in clusters, and can indicate a platelet or clotting disorder. Any non-blanching rash that appears acutely alongside bruising, fever, or illness warrants prompt medical attention.

Pyogenic granuloma — a fast-growing, bright-red to pink nodule that bleeds very easily and profusely with minor trauma. It often develops over days to weeks and may have a collar of skin at its base. Clinically, a rapidly enlarging, freely bleeding lesion should not be assumed to be a cherry angioma.

Angiokeratoma — a darker, rougher-surfaced vascular lesion, often dark red to purple, with a slightly warty texture. May appear in clusters on a specific anatomical area.

Kaposi's sarcoma — rare; lesions can resemble cherry angiomas but are often more violaceous, have irregular borders, and appear in a person with immunosuppression or HIV. Dermoscopy and biopsy distinguish these reliably.

A clinician can usually confirm the diagnosis of cherry angioma by clinical appearance alone. Dermoscopy — a handheld skin surface magnifier — shows a characteristic pattern of lacunae (round red-to-violet structures) that is distinct from other vascular lesions and rarely requires a biopsy.

When should a sudden crop of new cherry angiomas prompt evaluation?

For most adults, new cherry angiomas accumulate gradually over years. A sudden appearance of many new lesions in a short time — sometimes called eruptive cherry angiomatosis — is uncommon and has been associated in rare cases with underlying conditions including lymphoproliferative diseases such as multicentric Castleman disease 8Ref 8Fajgenbaum DC, Rosenbach M, van Rhee F, Nasir A, Reutter J (2013).Eruptive cherry hemangiomatosis associated with multicentric Castleman disease: a case report and diagnostic clue.Eruptive cherry hemangiomatosis as presenting sign of multicentric Castleman disease; IL-6/VEGF mechanism; recommendation for evaluation when eruptive onset accompanies systemic symptoms, immunosuppression, graft-versus-host disease, and certain medications.

The proposed mechanism in some of these cases involves elevated interleukin-6 driving hypersecretion of vascular endothelial growth factor 8Ref 8Fajgenbaum DC, Rosenbach M, van Rhee F, Nasir A, Reutter J (2013).Eruptive cherry hemangiomatosis associated with multicentric Castleman disease: a case report and diagnostic clue.Eruptive cherry hemangiomatosis as presenting sign of multicentric Castleman disease; IL-6/VEGF mechanism; recommendation for evaluation when eruptive onset accompanies systemic symptoms. Eruptive cherry angiomatosis accompanied by systemic symptoms — fever, unintentional weight loss, lymph node swelling, or fatigue — warrants evaluation rather than reassurance alone.

For most people, though, new lesions accumulating gradually over years are expected and do not require investigation beyond the clinical exam.