Lesions may be found on all body sites, but usually, the mucous membranes are spared. Most patients report an increase in number and size of individual lesions with advancing age. Rarely, a lesion demonstrates a dark brown to an almost black color when a hemorrhagic plug occupies the vascular lumen, often raising concern about the possibility of a malignant melanoma. Several reports have described the appearance of many small red papules histologically resembling cherry hemangiomas in patients with malignancies, although most lesions occur in healthy patients. On scanning magnification, a sharply circumscribed vascular proliferation usually is noted, often embraced in part by a collarette of epithelium and adnexal structures.
Higher magnification demonstrates numerous venules in a thickened papillary dermis.
Older lesions often display prominent collagen bundles, which is an appearance suggesting septa. Medical intervention is not helpful and not indicated in the treatment of the benign vascular proliferations of cherry hemangiomas. Perform biopsy on lesions in which the diagnosis is doubtful. The biopsy procedure may be used as a therapeutic measure to remove traumatized or bleeding lesions. The risk of scarring usually is minimal when the technique is performed by a skilled operator.