Angiosarcoma is a rare head and neck sarcoma of vascular endothelial cell origin. We report a case of angiosarcoma in an elderly male, and the multidisciplinary approach employed in his treatment.
A 79-year-old male presented with a 4-month history of a rapidly enlarging black, soft, immovable tumor surrounded by bruise-like patches over the right temporoparietal scalp. There was associated pruritus and bleeding when scratched. Dermoscopy showed bluish black crusts over the tumor, and surrounding violaceous patches. Wedge biopsy revealed a dermis with irregular vascular spaces infiltrating dermis, lined by atypical endothelial cells. Immunohistochemistry of the atypical infiltrative cells was positive for CD31. These findings were consistent with angiosarcoma. The patient underwent wide excision with a rotational flap and split thickness skin graft. Postoperatively, the patient was referred to Oncology for adjuvant radiation
Even with treatment, the prognosis of angiosarcoma remains poor due to its aggressive nature, with a 5-year survival rate ranging from 10-54%. However, early detection of the disease may increase patient survival rates. This rare case shows the importance of maintaining a high level of suspicion for lesions that have an atypical presentation to prevent delays in management and improve patient outcomes.