Chapter 30: Cherry and Spider Angiomas

INTRODUCTION

Cherry angiomas, also known as ruby spots, senile hemangiomas, acquired capillary hemangioma, and Campbell de Morgan spots are very common benign vascular lesions that predominantly affect the trunk. Spider angiomas, also known as nevus araneus, spider telangiectasia, arterial spider, and vascular spider, represent localized telangiectasias radiating from central feeding arterioles. They are common vascular lesions that predominantly affect the face, upper trunk, arms, and hands.

EPIDEMIOLOGY

Incidence: very common

Age: cherry angiomas—middle-aged and elderly people; spider angiomas—all ages

Sex: more common in females

Precipitating factors: cherry angiomas can erupt during pregnancy or with hepatic disease. Spider angiomas are strongly associated with pregnancy, intake of oral contraceptive pills, and hepatocellular disease

PATHOGENESIS

Unknown for both. Association with pregnancy, oral contraceptive use, and liver disease suggest a hormonally mediated angiogenic mechanism.

PHYSICAL EXAMINATION

Cherry angioma presents as a 1-to-3-mm bright red to violaceous, smooth, dome-shaped papule. Spider angioma displays a network of dilated capillaries radiating from a central vessel. Both may bleed when traumatized.

PATHOLOGY

Cherry angiomas show loss of rete ridges as well as congested and ectatic capillaries and postcapillary venules in the papillary dermis. Spider angiomas reveal a central ascending arteriole that branches and communicates with multiple dilated capillaries.

DIFFERENTIAL DIAGNOSES

Cherry angiomas can be mistaken for angiokeratoma, glomeruloid hemangioma, pyogenic granuloma, and nodular melanoma. Spider angiomas can be mistaken for generalized essential telangiectasias and hereditary hemorrhagic telangiectasia.

COURSE

Cherry and spider angiomas arising during pregnancy may regress postpartum. Spider angiomas arising in childhood may also resolve spontaneously. Otherwise, both lesions tend to persist.

MANAGEMENT

Although medically insignificant, cherry and spider angiomas are frequently treated for cosmetic purposes. Multiple effective surgical treatment options exist. Depending on the procedure selected, the cost to the patient may vary significantly. Cherry and spider angiomas that present during pregnancy should not be treated until several months after delivery as they may resolve on their own.

• Electrosurgery

  • – Electrodessication with coagulation (monopolar setting, 1–2 W followed by gentle curettage with endpoint of lesional flattening and hemostasis) has been the traditional treatment modality for these lesions.

  • – It is effective and easily accessible.

  • – The potential for scar formation must be considered.

• Laser surgery: different lasers have been used successfully in treatment of cherry and spider angiomas.

  • – Pulsed dye laser (PDL) is the treatment of choice. A spot size should be selected that matches diameter of the angioma. With spider angiomas, the central feeding vessel as well as the surrounding vessels should be treated. It is best to compress the lesion with a microscope slide to blanch all ...