Cherry Angiomas: Small Red Spots and Laser Treatment

Cherry angiomas are tiny, bright red bumps made of a small cluster of blood vessels, and they become more common as we get older. They are benign and need no treatment for health reasons, but if they bother you, a vascular laser can usually shrink or clear them in one or two sessions. Any red spot that looks different, bleeds or changes quickly should be checked by your doctor first.

What cherry angiomas look like and why they appear

A typical cherry angioma is a round, smooth, ruby-red to purple spot, from the size of a pinpoint to a few millimetres across. Small ones are flat; larger ones may be dome-shaped and soft. They show up most often on the chest, abdomen, back and upper arms, though they can appear almost anywhere.

Many people notice their first few in their thirties, and the number tends to rise with each decade. Family tendency seems to play a strong role. Pregnancy and hormonal shifts may bring on new ones, and some research has looked at links with certain chemical exposures, although for most people no specific cause is found. They are not caused by poor health, diet or anything you did wrong.

Cherry angiomas do not turn into cancer. They may bleed if scratched, caught on clothing or nicked while shaving, which is a common reason people ask about removal.

When a red spot needs a doctor's look

Most small red spots that look like cherry angiomas are exactly that. Still, a few other conditions can resemble them, and some need medical care. See your family doctor before any cosmetic treatment if a spot:

• Grows quickly over days to weeks, or bleeds easily and repeatedly
• Is dark brown, black or very uneven in colour
• Is crusted, ulcerated or does not heal
• Is part of a sudden crop of many new spots in a short time
• Appears along with fever, bruising, fatigue or other symptoms

Look-alikes include pyogenic granuloma, a fast-growing bleeding bump that often follows minor injury, angiokeratomas, and, rarely, skin cancers such as amelanotic melanoma that lack the usual dark pigment. Tiny flat red or purple dots that do not fade when pressed can be a sign of a blood or clotting problem and need prompt medical attention. Our article on checking moles and when to worry covers general warning signs.

How Nd:YAG laser treats them

Haemoglobin, the pigment in red blood cells, absorbs certain laser wavelengths well. The Fotona system includes an Nd:YAG wavelength (1064 nm), which passes into the skin and is taken up by the blood inside the angioma. The heat closes off the small vessels, and over the following weeks the body clears the treated tissue.

Each spot is treated with one or a few short pulses, often with cooling of the skin surface. The sensation is usually described as a brief hot snap. Many people do not need numbing for a handful of small spots, though a numbing cream can be used for larger areas. Small angiomas often turn grey or darker straight after a pulse, which is an expected response.

Other options include electrocautery (a fine heated needle), other vascular lasers and, for larger raised lesions, a shave removal. Your clinician can explain which approach fits the size and location of your spots.

How many sessions you may need

Pinpoint and small angiomas frequently clear after a single session. Larger, raised ones may need a second or third treatment spaced about four to six weeks apart, so each round can heal fully before the remaining tissue is retreated. Results vary from person to person.

A treated angioma that clears is generally gone for good, but laser does not stop new ones from forming. Many people find they develop more over the years and choose to have a few treated every so often.

Healing and aftercare

Treated spots may look like a small bruise or a dark dot for one to two weeks. A tiny crust can form on larger lesions and should be left to fall off on its own. Mild redness around the spot usually settles within a day or two.

Keep the area clean, avoid picking, and protect treated skin from the sun while it heals. On areas covered by clothing, loose fabrics help reduce rubbing. Strenuous exercise and hot baths are often avoided for a day if there is swelling.

Who should not have it, or should wait

Laser may not be suitable, or may need to be delayed, if you:

• Have a spot that has not been confirmed as a cherry angioma
• Are pregnant (new pregnancy-related spots sometimes fade afterward)
• Have a tan, recent sunburn or are using self-tanner on the area
• Have an infection or rash in the treatment area
• Have recently taken isotretinoin or tend to form keloid scars
• Take medicines that make the skin more sensitive to light

If you take a blood thinner, bring it up at your consultation. Do not stop it on your own.

Risks and side effects

Common, short-lived effects include redness, mild swelling and bruising. Less common risks include blistering, a small crust that takes longer to heal, temporary darkening or lightening of the skin, and, rarely, a small pitted or raised scar. Darker skin tones have a higher chance of pigment change, so settings are chosen conservatively and a test spot may be suggested.

Frequently asked questions

Why do I keep getting more of them?

New cherry angiomas are a normal part of skin ageing for many people, and genetics strongly influences how many you develop. Getting more does not usually mean anything is wrong.

Can I cut or burn one off at home?

Please do not. Home removal can cause heavy bleeding, infection and scarring, and it removes the chance to have an unusual spot checked properly.

Is it worth treating them at all?

Only if they bother you or catch and bleed. Leaving them alone is a perfectly reasonable choice.

Considering treatment

If you would like your red spots assessed, HealthPark Medical Aesthetics offers consultations where each spot is examined, anything unusual is referred back to your doctor, and the likely number of sessions, risks and fees are explained before you decide.