Cherry angioma, spider angioma or venous lake: how to tell small red marks apart before treatment

Cherry angiomas, spider angiomas and venous lakes are all common, usually harmless blood-vessel marks, but they differ in appearance, location and behaviour. A cherry angioma is a small firm red-to-purple bump. A spider angioma has a central red point with fine vessels fanning out and fades when pressed. A venous lake is a soft blue-to-purple spot, most often on the lip or ear, that flattens when pressed. Looks alone cannot confirm any of them. A new, changing or bleeding red mark should be checked by a GP or dermatologist before anyone considers cosmetic laser.

This guide helps you describe your mark and prepare questions. It is not a diagnosis.

How do the three marks compare?

	Cherry angioma	Spider angioma	Venous lake
Typical look	Firm red, blue or purple bump, roughly 0.1–1 cm	Small central red spot, sometimes raised, with fine red vessels radiating out	Soft, squashable blue or purple spot, flat or dome-shaped, roughly 0.2–1 cm
Usual sites	Trunk and limbs; often several	Face, upper chest, back, upper arms	Lower lip most often; also ears, face, neck
Who gets them	Increase from around age 40	Children and adults; linked with higher oestrogen such as pregnancy or the pill	Mainly people over 50
Pressing the mark	Not a reliable test	Briefly disappears, then refills	Empties and flattens, then refills
Usually needs treatment?	No	No	No, unless bleeding or sore

Sources: DermNet on cherry angioma, British Association of Dermatologists leaflet on spider angioma, BAD leaflet on venous lake and DermNet on venous lake. Sizes differ slightly between sources, so treat them as rough ranges.

What does a cherry angioma look like?

DermNet describes it as a symptom-free, firm red, blue or purple bump, usually several rather than one, mostly on the body and rarely on the hands, feet or mucous membranes. Numbers tend to rise from about age 40. The cause is unknown. A lesion that has bled or clotted can look almost black, which is one reason a dark-looking "mole" should not be assumed to be an angioma. DermNet

The MSD Manual (reviewed August 2025) says cherry angiomas are benign and treatment is usually only for bleeding or cosmetic concerns. MSD Manual

What does a spider angioma look like?

The BAD leaflet describes an enlarged skin vessel with smaller vessels branching from it, up to about 1 cm across. Brief pressure makes it disappear and it refills when released. It reports that at least one in ten healthy adults has one, and that they can appear when oestrogen is higher, for example in pregnancy or on the contraceptive pill. They may occasionally occur in people with liver or thyroid disease. Those linked to pregnancy or the pill often fade within about nine months of hormone levels settling, and the leaflet says spider angiomas are not usually treated on the NHS. BAD leaflet

Most people have one or a few. If you suddenly notice many new ones, or have other symptoms, mention it to your GP rather than assuming it is cosmetic.

What does a venous lake look like?

The BAD leaflet calls it a small enlarged vein in the skin, often blue or purple, commonly on the lower lip, usually on sun-exposed skin and mostly in people over 50. Pressing it drains the blood so it flattens, then it refills. Long-term sun exposure and smoking may contribute. If knocked or caught it may become painful or bleed. BAD leaflet

A dark mark on the lip is not automatically a venous lake. Treat a dark, firm, non-compressible, changing or bleeding lip lesion as something for a doctor to assess.

Which red marks should a doctor look at first?

The NHS advises getting a GP to check a mole or mark that changes in size, shape or colour, is painful or itchy, is inflamed, bleeding or crusty, or is a new or unusual mark that has not gone away after a few weeks. NHS melanoma symptoms (last reviewed 15 July 2026).

Why this matters for red marks:

• Look-alikes exist. DermNet lists amelanotic melanoma (a melanoma lacking brown pigment), nodular basal cell carcinoma and pyogenic granuloma among the conditions cherry angiomas can be confused with. DermNet
• A fast-growing, easily bleeding red lump is not a typical angioma. The BAD leaflet describes a pyogenic granuloma as a rapidly growing red lump that can bleed profusely, and says doctors may remove it and send it to a laboratory if in doubt. BAD pyogenic granuloma leaflet (its listed review date, October 2025, has passed).
• Atypical or rapidly changing lesions may need biopsy to exclude cancer. MSD Manual
• A sudden crop of many new cherry angiomas is uncommon; the MSD Manual notes it can be associated with other conditions, so it is worth raising with a GP. MSD Manual

Photograph a mark with a ruler or coin beside it. That gives whoever examines it something to compare against.

Is laser an option, and is it available on the NHS?

For all three, treatment is usually optional. Laser targets blood in the vessel. DermNet lists cryotherapy, electrosurgery and vascular laser for cherry angiomas, and cryotherapy, electrocautery, sclerotherapy, intense pulsed light and vascular laser for venous lakes. The BAD leaflet lists pulsed dye, Nd:YAG or KTP lasers and electrodessication for spider angiomas. The MSD Manual says no single method is clearly superior for cherry angiomas. DermNet, BAD spider angioma

Practical points from the sources:

• NHS: The BAD leaflets say laser may not be available on the NHS for venous lakes and that spider angiomas are not usually treated. North Bristol NHS Trust says laser for spider naevi is not routinely funded, though its Exceptional Funding Panel may consider severe cases. North Bristol NHS
• Risks: The BAD leaflets mention colour change, scarring and a possible small dent after spider angioma treatment, and say venous lake treatments usually leave a mark, so "one blemish is exchanged for another". Recurrence and repeat treatment are possible for spider angiomas.
• Cryotherapy comparison: For venous lakes, the BAD leaflet says freezing can swell, blister and crust for about 10 to 14 days and usually heals with a pale scar.
• Sessions and recovery vary: One NHS laser service describes a possible second session about eight weeks later for spider naevi and about a week of bruising. That is one service's protocol, not a general rule. Your practitioner will confirm what applies to you.

Be cautious of unsourced claims such as "no scarring", "permanent" or a stated success rate. Venous lake evidence is largely small case series and non-randomised studies, so exact percentages should not be treated as guarantees.

What should you ask before booking laser?

• Has a doctor or the practitioner assessed this specific mark, and what is it?
• What happens if the mark does not look typical? Who assesses it, and is tissue sent for testing if something is removed?
• Which laser or other method is proposed, and why for this mark and my skin?
• How many sessions might be needed, and what will we review before booking more?
• What are the realistic risks of marks, colour change or scarring in my case?
• What does the full cost include, and is a consultation charge credited?

Discussing small vascular marks at Progen in Bournemouth

Progen's vascular lesions and small vessels page says that thread veins, angiomas, spider angiomas, haemangiomas and venous lakes can be treated with laser after a consultation to check suitability. If a mark is new, changing, bleeding or unclear, get it checked by a GP first and bring that advice to your consultation.

If your concern is background redness or facial thread veins rather than a single mark, see our guide to facial thread veins versus rosacea.

See Progen's vascular lesion laser treatment page for the consultation pathway and aftercare information.

Frequently asked questions

Can I tell a cherry angioma from melanoma myself?

No. Cherry angiomas are usually smooth, red and stable, but amelanotic melanoma can look red or pink. A mark that is new, changing, bleeding, crusting or has not gone away after a few weeks should be checked by a GP, as NHS guidance advises.

Does a spider angioma mean there is a liver problem?

Usually not. The BAD says spider angiomas affect at least one in ten healthy adults and often relate to oestrogen changes such as pregnancy or the pill. They may occasionally occur with liver or thyroid disease, so mention many new ones or other symptoms to your GP.

Does the NHS remove venous lakes or cherry angiomas?

Usually not for cosmetic reasons. The BAD says laser may not be available on the NHS for venous lakes, and treatment is generally unnecessary unless there is recurrent bleeding or soreness. A GP can advise about a mark that bleeds or worries you.

Can laser guarantee a venous lake or angioma will not come back?

No. Response varies, repeat treatment may be needed, and scarring or colour change is possible. Ask your practitioner what to expect for your mark and how progress will be reviewed.

See Progen's vascular lesion laser treatment page

Sources and further information

• Accessed 2026-11-05. Cherry angioma: firm red/blue/purple bump about 0.1–1 cm, usually multiple, increasing from about age 40, unknown cause; differentials include spider telangiectasis, pyogenic granuloma, nodular BCC and amelanotic melanoma; options cryotherapy, electrosurgery, vascular laser.
• Accessed 2026-11-05. Venous lake: soft compressible blue/purple macule or papule about 0.2–1 cm, most often lower lip; removal options listed; scab and possible scar.
• Accessed 2026-11-05. BAD leaflet: spider angioma blanches on pressure, at least 1 in 10 healthy adults, hormonal association, occasional liver or thyroid disease, vascular lasers, not usually NHS-treated, small scar possible.
• Accessed 2026-11-05. BAD leaflet: venous lake enlarged vein, blue/purple, lower lip, mostly over 50, sun exposure and smoking may contribute, treatment unneeded unless bleeding/soreness/cosmetic, cryotherapy 10–14 days crust and pale scar, laser may not be on NHS, scarring/colour change risk.
• Accessed 2026-11-05. Pyogenic granuloma is a rapidly growing red lump that can bleed profusely; doctor may remove and send for testing if in doubt.
• Accessed 2026-11-05. One NHS laser service: pulsed dye laser for spider naevi, possible second session about eight weeks later, bruising about a week, not routinely NHS-funded.
• Accessed 2026-11-05. See GP for a mole or mark that changes in size, shape or colour, is painful, itchy, inflamed, bleeding or crusty, or a new unusual mark persisting after a few weeks.
• Accessed 2026-11-05. Cherry angiomas benign; dermoscopy red/purple lagoons; biopsy generally indicated for atypical or rapidly changing lesions in melanoma-prone patients; eruptive onset can be associated with other disease; no single treatment clearly superior.
• Accessed 2026-11-05 via the site source (treatment-pages.json). Progen advertises laser treatment after consultation for thread veins, angiomas, spider angiomas, haemangiomas and venous lakes.