Cherry hemangiomas are found in individuals of all races and ethnic backgrounds. No distinction can be made on the basis of sex. In the past, the lesions often were referred to as senile angiomas. Cherry angiomas typically present in the third or fourth decades of life, and early lesions may appear as small red macules. 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.