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  • Although many vascular tumors overlap morphologically, they can often be differentiated by the age of onset and histopathologic features.

  • Most vascular lesions are benign and do not require treatment.


  • The age of manifestation and progression or regression of vascular lesions can be helpful clues for diagnosis.


  • Treatment options for vascular lesions are constantly expanding, with increased expertise and study of laser therapies and immunotherapy.


  • Patients and caregivers should be educated on the benefits and risks of active nonintervention as well as cutting-edge therapies.


Vascular tumors can initially appear to be very similar, but differentiation can be achieved in most cases by clinical course, including age at manifestation and the presence or absence of proliferation or regression. Further differentiation can be achieved through histopathologic analysis and immunohistochemistry.

In this chapter, we present a broad working classification of vascular tumors, distinguished by their biologic potential: benign; locally aggressive or borderline; and overtly malignant. We review the clinical presentation of each tumor, key histopathologic features, immunohistochemistry, and recommended management. Of note, telangiectatic lesions, vascular malformations, and vascular proliferations of infectious etiology (bacillary angiomatosis and verruga peruana) are not discussed in this chapter.


Cherry Angioma


Cherry angiomas are the most common benign acquired vascular proliferation. In 2019, GNAQ and GNA11 mutations were identified in cherry angiomas, further expanding our knowledge of the range of benign and malignant phenotypes that can be caused by these somatic mutations.1

Clinical Features

Cherry angiomas appear as small, round to oval, bright red papules (Figure 19-1). They develop in early adulthood and often increase in number and size over time. They may be associated with some medical conditions, including pregnancy and elevated prolactin levels.2 They are most commonly located on the trunk and extremities but can appear anywhere on the body. They are usually asymptomatic but may bleed if traumatized.2

Figure 19-1

Multiple erythematous compressible papules consistent with cherry angiomas. Reproduced with permission from Bolognia JL, Jorizzo JL, Schaffer JV, et al: Dermatology, 3rd ed. London: Elsevier Saunders; 2012.

Histopathological Features

On histology, cherry angiomas display a polypoid architecture with an epidermal collarette. They are composed of ectatic, congested capillaries within the papillary and superficial reticular dermis.


Due to their benign nature, cherry angiomas do not necessitate treatment. However, if they are cosmetically bothersome or frequently traumatized and removal is desired, they can be treated with shave removal, electrodesiccation, or laser ablation.

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