Dermatology Case Studies

A is for Asymmetry

• A cherry angioma is usually symmetrical, whereas melanoma and more concerning skin lesions are often irregular or asymmetrical in shape and/or colour
• In this case you can clearly see the spot is almost symmetrical

B is for Border irregularity

• A cherry angioma usually has smooth, even borders, whereas a melanoma often has irregular, blurry, or jagged edges and hard-to-define border
• In this case you can clearly see the photograph shows a well circumscribed spot with a smooth and regular border

C is for Colour variability and/or Changing colour

• A cherry angioma usually has a single shade of colour, the striking cherry red appearance that can be seen in the photograph this lady has submitted
• The colour demonstrated is a reassuring feature here; it should be noted, however, that angiomas can be darker in colour with some having a much darker or black appearance
• This illustrates the need to carefully check all skin lesions carefully using the ABCDE criteria
• Because cherry angiomas are caused by a small collection of blood vessels in the skin, another feature they can have is that of "blanching"
• This means that they disappear or fade dramatically when pressure is applied with a finger or pen top; when the pressure is released, they reappear usually within a few seconds
• This would not normally be a feature of melanomas and more concerning skin lesions

D is for Different

• Cherry angiomas can occur alone but often occur as multiple small spots anywhere on the skin surface, although not normally on the hands and feet
• Where patients have multiple angiomas you would expect them to look broadly similar; any that do not would warrant special attention

E is for Evolving (changing)

• A cherry angioma is usually stable and does not increase in size, colour and general shape
• In this case the patient is telling you that the spots have appeared over the course of a year and stay much the same once they occur
• These are both reassuring points in the history