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Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of large B-cell lymphoma characterized by the exclusive growth of lymphoma cells within blood vessels. Due to the lack of lymphadenopathy and mass formation, the diagnosis of IVLBCL is frequently delayed. Random biopsies of normal-appearing skin are recommended to diagnose patients suspected of having IVLBCL. Although their usefulness is well recognized, the limitations and diagnostic utility of random skin biopsies for IVLBCL involving cherry angiomas have been reported in a limited number of cases. The current study presents the 21st reported case of IVLBCL with a cherry angioma, focusing on the strategies for diagnosing this malignant lymphoma. An 82-year-old Japanese man presented to Osaka Medical and Pharmaceutical University with a fever of unknown origin and general malaise. Laboratory tests revealed elevated levels of soluble interleukin-2 receptor and lactate dehydrogenase. No lymphadenopathies or masses were observed. Based on the results and presentation IVLBCL was clinically suspected, and a skin biopsy was performed at the site of the cherry angioma. The histopathological examination of the biopsy specimen demonstrated a collection of dilated capillary vessels in the upper dermis, filled with large lymphoid cells with irregularly shaped nuclei and nucleoli. Immunohistochemically, these lymphoid cells expressed cluster of differentiation (CD) 20, CD79a, multiple myeloma oncogene 1 and B-cell lymphoma 6. The patient was, therefore, diagnosed with IVLBCL within a cherry angioma. Although a limited number of cases of IVLBCL involving cherry angiomas have been reported, skin biopsies from cherry angiomas and random skin biopsies may be recommended for patients suspected of having IVLBCL, as they may be reliable detectors of lymphoma cells. [ABSTRACT FROM AUTHOR]