Several reports have described the appearance of many small red papules histologically resembling cherry hemangiomas, in patients with malignancies. However, a vast majority of lesions occur in patients who are healthy. The diagnosis is generally made clinically, however, biopsy allows for histopathological confirmation in doubtful situations. A skin biopsy, either shave or punch, will permit histological confirmation of the diagnosis. On scanning magnification a sharply circumscribed vascular proliferation is generally 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, an appearance suggesting septa. In general, no therapy is warranted for these benign vascular proliferative lesions. Biopsy should be performed on any lesion in which the diagnosis is doubtful, and may be used as a therapeutic measure to remove traumatized or bleeding lesions. Ablation of lesions utilizing the pulse dye laser may be employed for cosmesis. Treatment for these lesions is recommended only in situations of irritation or hemorrhage, as well as instances in which they are deemed cosmetically undesirable by the patient.