Cherry hemangiomas are benign tumors of the vascular endothelium. They represent vascular lesions of the subcutaneous tissue, resulting from excessive proliferation of cutaneous blood vessels. They typically develop after birth, grow during the first months of life, and become increasingly common after the age of 30–40. They may appear on any part of the body, exhibiting a red or bluish color, and consist of dysplastic vessels with structural and functional abnormalities. They are most often observed as “strawberry-like” hemangiomas.
Types of Hemangiomas
They are classified based on depth into:
Superficial: Located near the skin surface.
Deep: Situated deeper within the dermis, with less visible features.
Mixed: Exhibit both superficial and deep characteristics.
Pathophysiology
Although the precise pathogenesis remains unclear, the following mechanisms are implicated:
Age: More common in infants, but also in adults due to alterations in microvascular circulation, skin aging, and chronic UV exposure.
Genetics: Possible hereditary predisposition.
Hormonal factors: Potential association with elevated estrogen and progesterone levels.
Chemicals and toxins: Exposure to organic solvents, bromide, and cyanide compounds.
Medications: Such as cyclosporine, interferon-alpha and -beta, among others.
Viruses: Including HSV-8, Epstein-Barr virus, hepatitis B and C, and HIV.
Immunologic and inflammatory endothelial processes.
Morphology
Lesions typically present as bright red, burgundy, or bluish papules, measuring 1–6 mm in diameter. They may be round or oval and slightly raised. Common locations include the trunk (back, chest), face, scalp, and upper extremities. Their number varies from a single lesion to hundreds, depending on age. They are soft and painless unless ulceration occurs.
Diagnosis
Diagnosis is primarily clinical and supported by dermoscopy. Biopsy is rarely required, reserved for cases with atypical features or rapid changes in size or morphology.
Natural Course
Rapid proliferation phase (first 6 months)
Stabilization phase (6–12 months)
Involution phase (2–5 years)
Post-involution phase (beyond 5 years) In 70–90% of cases, spontaneous regression occurs by the age of 7.
Potential Complications
• Cosmetic or functional impairment (e.g., vision, respiration) • Bleeding (following trauma) or secondary infection • Psychological distress
Indications for Treatment
• Ulceration or skin atrophy • Hemorrhage • Impact on vision, hearing, or breathing • Aesthetic concerns or social consequences
Modern Therapeutic Approaches
Surgical excision: Ideal before 12 months of age, taking advantage of the superior wound healing in infants.
Laser therapy: Targeted, painless, and safe; shown to halt lesion growth in 96% of cases.
Pharmacologic treatment – Propranolol: Inhibits further proliferation and accelerates regression.
Cryotherapy with liquid nitrogen: Suitable for small, uncomplicated lesions.
