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Red dots on the skin
Cherry angiomas: small benign vascular lesions, and the liver myth.
They are bright red dots, round, a few millimetres across, sometimes smooth and sometimes slightly raised. They appear mainly on the trunk, abdomen and arms, increase in number with age from around thirty onwards, and are benign vascular lesions: small proliferations of capillaries, nothing more.
It is worth addressing the most widespread belief straight away, because it is deeply rooted and concerns the wrong organ. Cherry angiomas are not a sign of liver trouble. The lesion associated with liver disease is a different one and is recognisable: the spider naevus, which is not a solid dot but has a central vessel from which branches radiate outwards, and which blanches if pressed at the centre before filling again. They are two different things, and confusing them leads to worrying about the wrong lesion.
The reason people bring them to a visit is almost always cosmetic — they are visible in swimwear, or they have simply increased in number and that is uncomfortable. They can be treated in the clinic, and the choice of approach is made by looking at the lesion: size, elevation and site matter more than quantity.
There is, however, a red picture that does not belong on this page, and it is right to distinguish it. A reddish lesion that has appeared recently, grows rapidly and bleeds easily even after minimal trauma does not behave like a cherry angioma: it needs looking at, and looking at soon. It is not the same thing, and the difference is determined by a doctor, not by an appearance recalled from memory.
They have nothing to do with the liver: that is a different lesion
It is perhaps the most widespread belief about the skin, and it concerns two lesions that resemble each other only in colour. A cherry angioma is a solid, uniform dot, increasing in number simply with age. A spider naevus — the one historically associated with liver disease — has a central vessel with branches spreading around it and blanches under pressure before filling again. Telling them apart is immediate for someone looking with the right instrument, and the practical outcome is the opposite: in the first case there is nothing to investigate, in the second the conversation is different.
How it shows
- Round red dots, a few millimetres across, with sharp margins
- Smooth or slightly raised surface, bright red in colour
- Frequent sites: trunk, abdomen, arms
- Progressive increase in number with age
- No itching, pain or scaling
- Possible bleeding if the lesion is knocked or scratched
How we proceed
- 1Dermatological visit with dermatoscopic examination of the vascular lesions
- 2Distinction between cherry angiomas, spider naevi and other red pictures
- 3Exclusion of red lesions that warrant a different pathway
- 4Outpatient treatment of the lesions, when requested for cosmetic reasons
- 5Follow-up after treatment and assessment of any new elements
Available treatments
- Dermatology visit
- Dermatoscopic diagnosis
- Outpatient treatment of the lesion
- Follow-up
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Frequently asked questions
I am getting a lot of them in a short time: should I be worried?+
An increase in number over the years is the expected behaviour of these lesions and in itself indicates nothing. What deserves attention is not the quantity but the individual element behaving differently from the others: one that grows quickly, changes shape, or bleeds repeatedly without having been knocked. It is the criterion that applies to skin lesions generally — what matters is the one that stands out, not how many there are.
One bleeds every time I touch it: can I have it removed?+
Yes, and it is one of the most concrete reasons to treat them: a lesion in a site exposed to friction, such as the belt line or a bra strap, can bleed repeatedly and be a genuine nuisance. First, though, it should be examined, because easy bleeding is also a characteristic of red lesions other than cherry angiomas. That is not a reason to be alarmed: it is the reason for looking before treating.
Are they caused by the sun?+
Not in the way that spots or actinic keratoses depend on the sun. Cherry angiomas also appear at habitually covered sites, and the factor that weighs most is age. This does not change the fact that photoprotection remains recommended for reasons independent of these lesions: it is simply not the lever to pull to prevent them appearing.
Will more appear after treatment?+
New elements may appear at other sites, because the tendency to develop them remains and increases with age: it is the same logic as many benign skin lesions. The elements treated, on the other hand, do not come back. Allowing for this beforehand helps in reading the result correctly over the following months, without interpreting a new dot as a failure of the treatment done on another.
Related reading
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