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It is a growth of benign (non-cancerous) blood vessels that appear on the surface of the skin.
Angiomas are made up of vigorously growing endothelial cells , which generally form the lining of blood vessels.
Although an angioma can bleed, if injured, this shouldn’t cause any particular discomfort. It usually appears on the skin or near the surface of the skin.
Angiomas can appear anywhere on the body and are not considered dangerous. However, they may be present as symptoms of another more serious disorder, such as cirrhosis .
Types of angiomas
Common types of angioma that can be found include:
- Cherry angiomas.
- Spider angiomas (spider naevus).
- Angiomas cavernosos.
Cherry angioma
Cherry angiomas are also known as senile angiomas or Campbell de Morgan spots.
These growths have a maximum size of about six millimeters, are generally oval or circular in shape, and vary considerably in color.
Broken blood vessels often give them a reddish appearance, but they can also be blue or purple, and even the darkest ones are almost black.
Some appear flush with the surface of the skin, while others appear slightly raised.
Commonly associated with the aging process, cherry angiomas often begin to appear around age 40 and can then increase in number as the years go by.
A cherry angioma is a small to fairly large area, fairly common, benign, never malignant or cancerous.
Causes of cherry angiomas
While their cause is unknown, however, they tend to occur in people with a genetic predisposition.
Some environmental factors such as climate, chemicals, among others, can also influence.
Symptoms of cherry angiomas
Other than their appearance, they have no symptoms, although they may occasionally bleed.
Diagnosis and treatments
Cherry angiomas are easily diagnosable and can be removed quite easily by freezing or burning them, using lasers, or simply shaving them.
Spider angioma (spider naevus)
A spider angioma or spider snow is a type of angioma that is found slightly below the surface of the skin.
Spider angiomas are named for their spiderlike appearance; characteristically they are shown with a central red papule to which the feeding capillary branches are attached.
This type of angioma can be found in both children and adults.
They tend to increase in number when excess estrogen is present, as occurs during pregnancy.
People who have significant liver disease or in cases where liver function is below average also show many spider angiomas, as not enough clotting factors are being produced.
Spider angiomas are commonly found on the face, neck, upper trunk, and arms.
They can also be present on the backs of young children’s hands and fingers.
It is found in ninety percent of women and about eighty percent of them are affected before they reach the age of twenty.
They are frequent in pregnant women or those taking contraceptives.
Spider angioma is a collection of small, dilated blood vessels that clump together and occur very close to the surface of the skin.
This group of glasses is like a spider web and has a central spot with the glasses radiating from it; so the name is related to a spider web.
Causes of spider angioma
The cause of spider angioma is unclear.
According to research, there are certain factors that can lead to spider angioma, such as sun exposure, injury, fluctuations in hormone levels, and underlying medical problems, such as liver disease.
If there are multiple spider angiomas, this is a common indication of liver disease.
Patients with liver disease generally have five or more groups of vessels or arterioles at one time.
Many estrogens in the body generally result in the formation of a spider angioma.
This can be seen in conditions, such as chronic liver disease and pregnancy.
Spider angioma is more common in patients with liver cirrhosis, which is related to alcohol compared to patients with non-alcoholic cirrhosis.
In many patients, spider angioma is not a cause for medical concern, but in some patients there may be discomfort as a result.
Risk factors for spider angioma
Although the exact cause of spider angioma is not fully understood, there are several risk factors for this condition, such as:
- Age: As a person ages, the risk of developing spider angioma also increases. This could be because aging causes weakening of the valves in the blood vessels.
- Excessive sun exposure: mainly in those who have fair skin, which increases the risk of facial spider angioma.
- Hormonal changes: such as those that occur during puberty, pregnancy and menopause, and also when taking oral hormonal contraceptives can cause spider angioma.
- A family history of weak vascular valves increases the risk of having the same condition.
- Obesity: increases the risk of a spider angioma, since being overweight increases the pressure on the blood vessels that lead to the angioma.
- Standing or sitting for long periods of time: This hinders healthy blood circulation leading to the formation of clumps of blood vessels, such as spider angioma.
Spider angioma pathophysiology
Spider angiomas occur as a result of the dilation of pre-existing vessels and are not vascular proliferations.
Most lesions are not associated with any internal disease, but in some cases, spider veins are associated with thyrotoxicosis and are often found in conditions where there is excess estrogen, such as during pregnancy or when used oral contraceptives.
Spider angiomas can also be seen in liver disease, liver failure, and cirrhosis.
Spider angiomas when they have liver disease are numerous and large. They also tend to appear in unusual places.
Apart from spider veins, other results may also be present, such as palmar erythema, gynecomastia, muscle wasting, jaundice, ascites, splenomegaly, onychomycosis, and longitudinal nail striations.
The number of lesions present may be an indication of the extent of liver fibrosis.
Signs and symptoms of spider angioma
The only symptom, in most patients, is a red dot that is present in the center of the group of fine vessels.
These thin glasses are shaped like a spider web and can be blue, red, or purple.
Applying pressure on these groups will make them disappear, but they will reappear as soon as the pressure is removed and the blood begins to flow back into the vessels.
Spider angioma is usually seen on the face, neck, and legs, but it can appear anywhere on the body.
Some patients will experience a burning sensation in the area of the spider angioma.
If the patient has no other symptoms or health problems, then spider angioma is completely harmless.
However, if the patient has other symptoms, such as a feeling of weakness, tiredness, swelling, yellow skin or eyes, then it is important to see the doctor as soon as possible.
If the patient has multiple groups of spider angiomas, it is also important to see a doctor as this may be an indication of an underlying liver problem.
Spider angioma diagnosis
The diagnosis of spider angioma can be made simply by looking at the appearance of the skin.
However, it is also important to diagnose the underlying cause of spider veins and exclude certain serious medical conditions, which led to the formation of these groups of vessels.
Your doctor will ask you questions about hormone supplements, alcohol, or other medications you are taking.
If liver problems are suspected, blood tests are done to confirm the diagnosis.
There is a liver disease test known as a liver panel, which can be done to look at the proteins and enzymes that the liver makes and excretes.
If the levels increase or decrease, this indicates the existence of liver disease.
Treatment for spider angioma
In most cases, treatment for spider angioma is not required, especially if the patient has no associated symptoms.
If spider angioma does not cause discomfort, itching, or burning, then they are not harmful.
If they cause all of the above problems or are present in more than one group, then treatment should be sought by first diagnosing and treating the underlying cause.
Treatment can also be done if the spider angioma causes embarrassment to the patient and you want to remove it for cosmetic purposes.
Laser treatment is one of these treatments that acts on spider angioma making it gradually disappear.
Laser treatment can emit heat, causing pain and discomfort for the patient, but it disappears after treatment.
Two to five sessions of laser treatment are required to completely remove spider angioma.
Spider angioma prevention
Spider angioma may not be completely preventable.
If the patient is predisposed to this disease by genes and family history, the patient is at increased risk for spider angioma, no matter what he does to prevent it.
Some steps can be taken to prevent the formation of new spider angiomas such as wearing sunscreen when out in the sun, especially on the most commonly affected areas, such as the face, neck, and legs.
Angiomas cavernosos
Cavernous angiomas are vascular lesions composed of abnormally dilated groups of blood vessels.
These lesions can be found in the brain, spinal cord, and rarely in other areas of the body, including the skin and retina. Multiple names refer to this condition:
- Angioma cavernoso.
- Hemangioma cavernoso.
- Brain cavernous malformation.
- Cavernoma.
Cavernous angiomas are generally described as having a raspberry-like appearance due to their composition of multiple bubble-like structures called caverns.
Each cave is filled with blood and lined by a specialized cell layer called the endothelium.
Endothelial cells are the building blocks that work together with other types of cells to form blood vessels.
In the case of cavernous angioma, bubble-like caverns are highly dilated vessels due to defects in the endothelial cells and due to the loss of other structural components that are required for normal vessel walls.
Patients may present with one or more cavernous angioma lesions.
The size of the lesion varies, from microscopic to a few inches in diameter, and lesions can cause a wide variety of symptoms including seizures, stroke symptoms, and bleeding.
Incidence
Cavernous angiomas are estimated to occur in about one in 500 to 600 people, or about 0.2% of the general population.
Although the presentation of cavernous angioma is not uncommon in children, people often show the first sign of symptoms in their 20s or 30s.
Generally, more than 30% of those with cavernous angioma will eventually develop symptoms.
Types of cavernous angioma
Angioma cavernoso familiar
For at least 20% of people with the disease, cavernous angioma is inherited.
This form of the disease is often associated with multiple cavernous angiomas.
Although familial cavernous angioma can occur in any family, it occurs at a higher rate among Hispanic American families.
This prevalence in Hispanic American families is due to a specific genetic mutation that has been transmitted through up to 17 generations within this cultural group.
Research has shown that there are at least three genes that cause the familial form of cavernous angioma; inheritance of a causal mutation or deletion in any of these genes can lead to disease.
Sporadic cavernous angioma
In addition to the familiar form, cavernous angioma can arise sporadically. Under this condition, there is no associated inherited genetic mutation.
This sporadic form presents as a solitary angioma that can present from birth or can develop throughout the individual’s life.
Because sporadic lesions do not arise from genetic causes, related relatives will not have a predisposition for the condition.
Furthermore, the children of those with sporadic cavernous angioma may not have a greater chance of having cavernous angioma than anyone else – one in every 500 to 600 individuals.
Associated venous angioma
Venous angioma, also known as a venous malformation or developmental venous abnormality, generally does not create problems unless it is associated with a cavernous angioma.
It can make surgery more difficult; generally, the goal is not to alter the venous angioma while removing the cavernous angioma.
In some people, a venous angioma can lead to the development of more than one cavernous angioma.
Cavernous angioma symptoms
The symptoms of cavernous angioma are highly variable in some cases, there are no symptoms that may be present.
However, when symptoms do manifest, they often depend on the location of the cavernous angioma and the strength of the angioma walls and their propensity to bleed.
Cavernous angiomas can cause seizures, neurological deficits, such as weak arms or legs, vision problems, balance problems, fatigue, and / or memory and attention problems.
The type of seizure a person experiences depends, in part, on the location of the cavernous angioma.
Symptoms can come and go as the cavernous angioma changes in size with bleeding and blood resorption.
Cavernous angiomas can bleed in different ways:
- Angiomas can bleed slowly into the walls of the angioma and remain quite small. A small bleed may not require surgery and can be reabsorbed by the body. But small, continuous bleeds from the same angioma can often cause impaired function.
- Angiomas can bleed profusely into the walls of the angioma. This can cause them to enlarge and put pressure on the surrounding brain tissue.
- Finally, angiomas can bleed through a weak spot in the wall of the angioma into the surrounding brain tissue.
The greater the number of angiomas, the greater the chance that one or more bleeds will occur at some point in life.
On average, cavernous angiomas that have bled in the past are the most likely to bleed again, particularly in the first two years after the initial bleeding.
It is also important to note that a haemorrhage in a brain stem cavernous angioma can be life threatening, as the brain stem is responsible for regulating critical life processes such as breathing and heartbeat.
Finally, those patients with cavernous angioma may experience headaches.
This appears to be true particularly when an injury has recently undergone bleeding activity.
Diagnosis and treatment of cavernous angioma
Cavernous angiomas are most often diagnosed when they become symptomatic.
Although cavernous angiomas have been known since the 1930s, they had not been reliably diagnosed until the advent of MRI in the 1980s.
Previously, the disease may have been misdiagnosed as multiple sclerosis or as a seizure disorder with no known cause.
Cavernous angiomas are not visible on the angiogram and were only inconsistently visible on scans.
An MRI scan, with and without contrast and with gradient echo sequences or susceptibility weighted images, read by an experienced physician remains the best means of diagnosing this disease.
Medications are available to treat seizures and headaches caused by cavernous angiomas.
Surgery may be recommended for cavernous angiomas with multiple symptomatic bleeds and those that cause seizures.
Cavernous angiomas that are bleeding are more likely to have a second bleed within 2 to 5 years after the first bleed.
For familial cases of cavernous angioma, genetic testing is another option for diagnosis.
In many cases, the angiomas will not need to be removed or treated.
However, there may be an option to remove such growth for cosmetic reasons, or if its location makes it prone to regular bleeding due to frequent contact with abrasives.
Cavernous angiomas of the brain are surgically removed (resected) using a craniotomy or by opening the skull.
This is usually done under general anesthesia, except in cases where a brain mapping is needed while you are awake.
Cavernous angiomas in the spine are removed by laminectomy or splitting of the vertebrae.
Surgery for cavernous angioma has been made safer by using the operating microscope and image-guided surgical navigation (also known as computer-assisted stereotaxy) to reach the cavernous angioma with as little disruption as possible to the normal brain or spinal cord.
Surgery for cavernous angioma in the brainstem and spinal cord is riskier, but these cavernous angiomas are more dangerous if left alone.
While recovery is different for everyone, many patients leave the hospital within a few days and return to normal life within weeks of surgery.
However, people with neurological deficits may require a prolonged period of rehabilitation.
The most common procedures for angioma removal include:
Electrocautery
This procedure involves the use of a small electrical probe to burn the angioma.
Cryosurgery
This quick and relatively simple technique uses liquid nitrogen to freeze and eradicate the angioma.
Liquid nitrogen is a cold liquefied gas that is sprayed onto the skin with a spray gun.
This works by freezing and destroying the tumor in the blood vessels.
Vascular laser surgery
This procedure uses a pulsed dye laser to destroy the angioma.
Shaving excision
This method removes angioma growth from the surface of the skin, avoiding invasive surgery and stitching.
Another option is the use of stereotactic radiosurgery.
This is defined as a precise way to deliver radiation to the injury, without affecting the surrounding area of the brain.
This technique has been very successful in treating venous angiomas, but it is important that doctors can find the exact location of the injury.
Although an angioma is unlikely to go away, it shouldn’t cause any other problems.
Any angioma that begins to change, for example in color, shape or size, should be checked by a dermatologist.
