Synonyms: cherry haemangiomas, senile angiomas

These are common, benign skin lesions of middle to older age, formed by proliferating, dilated capillaries and postcapillary venules. They are named after an English surgeon, Campbell de Morgan (1811-76).

Aetiology¹

Their cause remains unknown:

• Chemical exposure (mustard gas, 2-butoxyethanol) causes multiple lesions to develop.
• Pregnancy and prolactinomas are associated with the development of lesions, implicating hormonal mediators.

Epidemiology

• These are the most common cutaneous vascular proliferation. Few reports have been published recently but there is evidence showing 75% of those over 75 years old may have them.²
• They increase in frequency and size with age.
• The most common age of onset is in the third and fourth decades of life.
• They are seen across all races and sexes.

Visual appearance

• 1-3 mm diameter macules which may become larger papules over time.
• Typical bright cherry red colour but can appear violaceous.
• They are non-blanching.

Presentation

• They usually occur on the trunk and extremities.
• They can be found at any skin site except the mucous membranes. The scalp has been reported.²
• Lesions may be widespread, especially in the elderly.
• They are usually asymptomatic.

Differential diagnosis³

• Malignant melanoma
• Spider naevi
• Pyogenic granuloma
• Kaposi's sarcoma
• Insect bite
• Angiokeratoma
• Congenital haemangioma

Primary care management

• Reassure - these lesions usually require no treatment.
• If removal is desired, treatment options include pulsed dye laser, electrocautery and excision.

When to refer

• When there is diagnostic uncertainty.
• When assistance with removal is required.
• Cryotherapy and carbon dioxide laser therapy are both options.²

Prognosis

• Campbell de Morgan spots are benign lesions.
• Problems only arise when lesions are frequently traumatised, continue to enlarge or are of cosmetic concern to a patient.
• There is a rare paraneoplastic association of the sudden onset of multiple new lesions with internal malignancy.

Document references

1. Luba MC, Bangs SA, Mohler AM, et al; Common benign skin tumors. Am Fam Physician. 2003 Feb 15;67(4):729-38. [abstract]
2. Kim JH, Park HY, Ahn SK; Cherry Angiomas on the Scalp. Case Rep Dermatol. 2009 Nov 11;1(1):82-86. [abstract]
3. Brown CW, Cherry Hemangioma, Medscape, Jun 2010

Internet and further reading

• Senile Angioma, DermIS (Dermatology Information System)
• Henry GI et al, Benign Skin Lesions, Medscape, Mar 2011