Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Noticing a handful of new red spots over a few months is unsettling, and the internet is unusually unhelpful on this one — liver disease, toxins and immune conditions all get mentioned. The short answer is that a crop of cherry angiomas is almost always age and genetics doing what they do. The longer answer is worth reading, because there is one lesion that does matter, and it is not the number of them.
What They Are, and Why More Keep Appearing
A cherry angioma is a small collection of dilated capillaries sitting just under the skin surface. Bright red or purple, usually 1–4 mm, sometimes flat and sometimes slightly domed. They are benign, they do not turn into anything else, and they are one of the most common skin findings in adults.
They appear in crops rather than one at a time, which is exactly why people notice them suddenly. Three things genuinely drive that:
- Age — by far the strongest factor
- They are uncommon before the age of thirty, become common through the forties, and are close to universal by seventy. The old name, Campbell de Morgan spots, is a nineteenth-century observation of exactly this pattern. Having more of them each decade is the expected course, not a change in your health.
- Genetics
- They run in families. If your parent developed a lot of them, you probably will too, and at a similar age.
- Pregnancy and hormonal change
- New cherry angiomas appearing during pregnancy are common and unremarkable. Some fade afterwards; many stay.
This is the most common conversation in the clinic on this subject. The answer given to someone who has noticed twenty of these appear over a year is worth quoting in full:
The vast majority of people who suddenly notice multiple cherry angiomas simply have a normal age-related tendency to develop them. They are very common, benign, and not related to an underlying illness. I’ll examine them carefully, but in most cases there isn’t a hidden medical cause.
Mr Onur Gilleard, Consultant Plastic Surgeon
The Claims You Have Read, Weighed Honestly
This is the part most pages get wrong, usually by repeating a possibility as though it were a finding.
The biggest myth I hear is that multiple cherry angiomas automatically mean liver disease — that simply isn’t true for typical cherry angiomas.
Mr Onur Gilleard, Consultant Plastic Surgeon
| Claim | Where it actually stands |
|---|---|
| “They mean liver disease” | This is a case of mistaken identity. The lesion associated with liver disease is the spider naevus, not the cherry angioma — a different thing that looks different. See below, because this single confusion causes most of the worry on this subject. |
| “They are caused by toxins or chemical exposure” | There are published case reports of eruptive cherry angiomas after heavy occupational exposure to certain chemicals, bromides in particular. Case reports describe what can happen in unusual circumstances; they do not explain the ordinary crop that appears on an ordinary person in their fifties. |
| “They signal autoimmune disease” | Not established. Cherry angiomas are so common in middle age that they will coexist with almost any condition by chance alone, and coexistence is not causation. |
| “They are a sign of vitamin deficiency or diet” | No evidence supports this, and no supplement removes them or prevents new ones. |
| “Stress causes them” | No evidence. They accumulate over years; stress is usually blamed because that is when the person looked. |
None of that means a new lesion should be ignored. It means the number of cherry angiomas is not the thing to examine yourself for.
Cherry Angioma or Spider Naevus — the Distinction That Matters
Almost every alarming article on this subject rests on conflating the two. They are different lesions with different significance.
| Cherry angioma | Spider naevus | |
|---|---|---|
| Appearance | A solid red or purple dot | A central red point with fine vessels radiating outwards, like a spider’s legs |
| Press it | Fades a little, refills evenly | Blanches completely, then refills from the centre outwards |
| Usual site | Trunk, upper arms, anywhere | Face, neck, upper chest, arms — the drainage area of the superior vena cava |
| Medical significance | None | A few are normal. Numerous spider naevi, particularly with other signs, can relate to liver disease, and are worth a GP appointment |
The refill test is the practical one: press the centre with a fingertip, release, and watch. Filling from a central point outwards means a spider naevus. If you have several of those and they are new, see a GP — that is a blood test conversation, not a cosmetic one.
How Many Is Normal?
There is no threshold above which a person becomes abnormal. There is, however, a real figure for what is typical, which most pages either avoid or invent.
A general population study imaged the entire skin surface of 163 adults in three dimensions and counted every lesion using an automated classifier. Median age 57. The result:
| Median number of cherry angiomas | |
|---|---|
| Men | 16 |
| Women | 12 |
Half of people carried more than that. Number and size both rose with age, and the commonest site was the front of the trunk, followed by the back — so a dozen or more scattered across the chest and abdomen in late middle age is not a crop, it is the median.
Source: Betz-Stablein B, et al. Anatomic distribution of cherry angiomas in the general population. Dermatology. 2022;238(1):18–26. PMID 34293748.
What is worth attention is still not the count but whether one of them is behaving differently from the others — and that is a question about a single lesion, not about the collection.
What that looks like in practice. A patient in their fifties came to the clinic having developed around thirty lesions over eighteen months, worried that it was cancer. Examination showed entirely typical cherry angiomas throughout, with nothing atypical among them. Several were subsequently treated with electrocautery and the cosmetic result was good — but the substantive part of that appointment was the examination, not the treatment.
The One Association With Published Support
Having dismissed the liver, toxin and autoimmune claims above, it would be dishonest to leave out the one finding that does have evidence behind it — and equally dishonest to present it without its limits.
An Italian cross-sectional study examined 1,190 people attending dermatology–oncology and dermoscopy clinics in Ferrara and Bologna. It recorded who had eruptive cherry angiomas, defined for the study as more than ten. Eruptive cherry angiomas were significantly associated with melanoma, particularly in people under 70, and the strength of that association was similar to having more than two clinically atypical moles. Having more than 40 ordinary moles was not associated with melanoma at all.
Now the limits, which matter more than the headline:
- This was not the general population. Everyone in it had been referred to a skin cancer service, so the proportion with melanoma is far higher than in the street.
- It is cross-sectional. It shows the two things occur together, not that one leads to the other, and not which came first.
- The threshold was arbitrary. “More than ten” was chosen by the authors, and as the figures above show, more than ten is the ordinary count for a middle-aged adult.
- It does not predict anything about you individually. An association across a thousand people is not a risk score for one.
So this is not a reason to fear your cherry angiomas, and anyone using this paper to sell you urgency is misusing it. What it reasonably supports is narrower and more practical: when someone comes in concerned about a lot of red spots, the sensible thing is to look at the whole skin rather than only the spots they pointed at — which is what a full assessment involves anyway.
Source: Borghi A, et al. Eruptive cherry angiomas and skin melanoma: further insights into an intriguing association. Dermatology. 2022;237(6):981–987. PMID 33254169.
The Lesion That Does Matter
Among a group of red spots that all look alike, the one to have examined is the one that does not fit.
- Growing quickly — over weeks rather than years
- Bleeding without being knocked, or bleeding repeatedly
- Changing colour, or developing a dark or crusted area
- Larger than the others, raised where the others are flat, or a different shape
- Painful or itchy, when cherry angiomas are neither
Three things can present as a red or pink lesion and are not cherry angiomas: a pyogenic granuloma, which grows over weeks and bleeds readily, often after a minor injury; an angiokeratoma, darker with a rough surface; and, uncommonly but importantly, an amelanotic melanoma, which can present as a pink or red bump rather than a pigmented one.
That last possibility is why a lesion that stands out from its neighbours is assessed rather than simply treated — two of the four removal methods destroy the tissue, leaving nothing to examine afterwards. The ugly duckling principle applies to red lesions just as it does to pigmented ones.
If One Bleeds
They bleed because they are made of blood vessels; catching one on a towel, a razor or a bra strap is usually all it takes, and it can bleed more than the size of the lesion suggests.
Firm, continuous pressure with a clean dressing for ten minutes stops the great majority. The common mistake is lifting the dressing every minute to check, which restarts it. Detail in what to do when a cherry angioma bleeds.
If You Want Them Gone
Removal is straightforward and is a cosmetic decision rather than a medical necessity — unless a lesion bleeds repeatedly, which is one of the few grounds on which it stops being purely cosmetic.
Two methods are used, matched to the lesion and the skin rather than applied uniformly: electrocautery for most lesions, raised or flat, and vascular laser for larger flat ones and where limiting pigment change matters in darker skin. Where there is any doubt about what a lesion is, it is shaved so the tissue can be examined rather than destroyed — a diagnostic step, not a treatment.
Between one and ten lesions are usually treated in one appointment, which takes twenty to thirty minutes. A consultation is £100. Removal is £200 for the first lesion and £100 for each additional one, or £600 for ten with further lesions at £50 each: cherry angioma removal. About 97% clear completely after a single treatment; where a second session is needed it is not charged.
Whether to treat them at all is a fair question, and the honest answer is not always yes. Asked directly whether cherry angiomas are over-treated, Mr Gilleard’s answer was that many are best left alone, because they are harmless and frequently not that noticeable in the first place.
Cherry angiomas are harmless, so treatment is entirely about symptoms or appearance rather than medical necessity.
Mr Onur Gilleard, Consultant Plastic Surgeon
One thing to be clear about before booking: removal clears the lesions you have. It does not change the tendency to form them, so new ones can appear elsewhere over the following years. That is expected rather than a failure of the treatment, and a clinic that implies otherwise is overselling.
Frequently Asked Questions
- Why have I suddenly got lots of cherry angiomas?
- Almost always age and genetics. They are uncommon before thirty, common through the forties and close to universal by seventy, and they appear in crops rather than singly, which is why they seem to arrive suddenly. Pregnancy and hormonal change also bring them on.
- Do cherry angiomas mean liver problems?
- No — this is a case of mistaken identity. The lesion associated with liver disease is the spider naevus, which has fine vessels radiating from a central point and refills from the centre outwards when pressed. A cherry angioma is a solid red dot with no radiating vessels.
- How many cherry angiomas are normal?
- In a general population study with a median age of 57, the median count was 16 in men and 12 in women, and half of people had more. There is no threshold above which it becomes abnormal. What matters is not the count but whether one lesion looks or behaves differently from the others.
- Are they caused by toxins or chemicals?
- There are case reports of eruptive cherry angiomas after heavy occupational exposure to certain chemicals, bromides in particular. Those describe unusual circumstances and do not explain the ordinary crop that appears with age.
- Can stress or diet cause them?
- No evidence supports either, and no supplement removes them or prevents new ones. They accumulate slowly over years; a stressful period is often simply when someone looked properly.
- Can a cherry angioma turn into skin cancer?
- No. It is benign and does not transform. The reason a red lesion is still examined is that a few other things can look similar — a pyogenic granuloma, an angiokeratoma, or uncommonly an amelanotic melanoma, which can present as a pink or red bump.
- I have read that lots of cherry angiomas are linked to melanoma. Is that true?
- There is a published association, but it is narrower than it sounds. A cross-sectional study of 1,190 people already attending skin cancer clinics found that having more than ten cherry angiomas was associated with melanoma about as strongly as having more than two atypical moles. It was a selected population, it cannot show cause, and more than ten is the ordinary count for a middle-aged adult. It is a reason to have the whole skin looked at rather than only the spots you pointed at — not a reason to be alarmed by the spots themselves.
- Which one should I get checked?
- The one that does not fit with the others: growing over weeks, bleeding unprovoked or repeatedly, changing colour, developing a dark or crusted area, noticeably larger or raised compared with its neighbours, or painful or itchy.
- Will they come back after removal?
- A treated lesion does not usually return, but removal does not stop new cherry angiomas forming elsewhere. That tendency is driven by age and genetics and is not changed by treating the ones you already have.
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