Section 07 of 08
Pitfalls and pulling it together
Common pitfalls
Assuming any red lesion is vascular and therefore benign. Colour tells you there is blood present, but it does not tell you the architecture is normal.
Always look for lacunar architecture. A red lesion without lacunae is not a confirmed cherry angioma — it is an uncharacterised red lesion that needs further evaluation.
Pulling it together
Cherry angiomas are one of the most recognisable lesions in dermoscopy, and identifying them confidently is a valuable clinical skill. The lacunar pattern — round, well-defined vascular compartments — is your anchor. When it is present and unambiguous, you can reassure the patient and move on.
But the broader lesson of this module is about vascular pattern recognition. You have learned that vessels under the dermatoscope have specific architectures, and that the architecture matters more than the colour. Neat compartments mean different things from irregular branching vessels, which mean different things from chaotic dotted vessels. This structural vocabulary will serve you well in every module that follows.
When you encounter a red or vascular-appearing lesion in practice, ask yourself three questions:
- Can I see lacunae? If yes, and they are unequivocal, this is likely a cherry angioma.
- Is the pattern complete? Lacunae plus sharp demarcation plus uniform colour equals confidence. Missing elements mean uncertainty.
- Does the clinical story match? A stable, small, well-defined red papule on the trunk of an adult fits. Rapid growth, bleeding, unusual location, or atypical patient context does not.
A 58-year-old patient has a 3mm red-purple papule on their upper back. Under dermoscopy, you see well-defined round compartments of uniform red-purple colour separated by thin pale lines, with a crisp border. Using what you have learned, what is your assessment?