Small, dome-shaped, red, cutaneous papules present on adults are likely cherry hemangiomas. Cherry hemangiomas are a proliferation of capillaries and post-capillary venules in the papillary dermis that will likely increase in number with time.
Capillary hemangiomas are small blood-filled capillaries lined by single layer endothelium. There are three major variants: cherry hemangiomas, strawberry hemangiomas, and port-wine stain. Cherry hemangiomas are usually multiple, permanent, and increase in number with time. Strawberry hemangiomas are bright-red raised lesions with initial rapid growth and spontaneous involution, that usually regress by age five. Port-wine stain, or nevus flammeus, refers to purple-red area on the face or neck. Usually the lesion is benign and present at birth, but sometimes it is associated with syndromes such as Sturge–Weber syndrome or Klippel–Trénaunay–Weber syndrome.
McLaughlin et al. describe hemangiomas of infancy, often referred to as strawberry hemangiomas. They note that the lesions occur in 1.1-2.6% of newborns and are present in 1% of infants at one year of age. Most strawberry hemangiomas will involute and disappear after infancy: 50% by five years of age, 70% by seven years of age, and 9% by 10 years of age.
Bauland et al. review the pathogenesis of hemangiomas. The authors noted that most theories focus on angioblast origins, trophoblast origins, mutations in cytokine regulatory pathways, and field defects as the cause of the deranged angiogenesis of hemangiomas. However, there is no single theory that explains all the characteristics of hemangiomas.
Image A shows several cherry hemangiomas. Illustration A shows a strawberry hemangioma. Illustration B shows a port-wine stain.
Answers 1 and 2: Strawberry hemangiomas, a benign capillary hemangioma of infancy, grow rapidly and then regress spontaneously.
Answer 3: Cavernous hemangiomas, a benign tumor of liver and spleen, are associated with von Hippel-Lindau disease.
Answer 5: Cherry hemangiomas are benign tumors not associated with cancer.
McLaughlin MR, O'Connor NR, Ham P. Newborn skin: Part II. Birthmarks. Am Fam Physician. 2008 Jan 1;77(1):56-60. Review. PubMed PMID: 18236823.
PMID:18236823 (Link to Abstract)
Bauland CG, van Steensel MA, Steijlen PM, Rieu PN, Spauwen PH. The pathogenesis of hemangiomas: a review. Plast Reconstr Surg. 2006 Feb;117(2):29e-35e. Review. PubMed PMID: 16462311.
PMID:16462311 (Link to Abstract)
USMLE World Step 1 QBank Question #826. Copyright © USMLEWorld, LLC 2012