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Angiosarcoma of the scalp in a 79-year-old male: A case report

Erika Kim R. Chan, MD, Charlene Marie U. Ang-Tiu, MD, FPDS, Mary Elizabeth S. Danga, MD, FPDS, Michael Jeff B. Fontano, MD, DPBS



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.


Case Report

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.


  1. Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller AS, Leffell D. Fitzpatrick’s Dermatology in General Medicine, 8th Edition. New York: McGraw-Hill,
  2. Patel SH, Hayden RE, Hinni ML, Wong WW, Foote RL, Milani S, Wu Q, Ko SJ, Halyard MY. Angiosarcoma of the scalp and face: the Mayo Clinic
    experience. JAMA Otolaryngol Head Neck Surg. 2015 Apr;141(4):335-40. doi: 10.1001/jamaoto.2014.3584. PMID: 25634014. Available from: https://
  3. Rampinelli H, Ramos-e-Silva M, Quintella D, C, Fernandes N, C: Cutaneous Angiosarcoma. Case Rep Dermatol 2018;10:55-60. doi: 10.1159/000485073. Available from:
  4. Buehler D, Rice SR, Moody JS, Rush P, Hafez GR, Attia S, Longley BJ, Kozak KR. Angiosarcoma outcomes and prognostic factors: a 25-year single
    institution experience. Am J Clin Oncol. 2014 Oct;37(5):473-9. doi: 10.1097/COC.0b013e31827e4e7b. PMID: 23428947; PMCID: PMC3664266. Available from:
  5. Wang H, Shi J, Liu H, Chen Y, Wang Y, Wang W, Zhang L. Clinical and diagnostic features of angiosarcoma with pulmonary metastases: A retrospective observational study. Medicine (Baltimore). 2017 Sep;96(36):e8033. doi: 10.1097/MD.0000000000008033. PMID: 28885371; PMCID:
    PMC6392612. Available from:
  6. Selim A, Khachemoune A, Lockshin NA. Angiosarcoma: a case report and review of the literature. Cutis. 2005 Nov;76(5):313-7. PMID: 16422466.
    Available from:
  7. Pawlik TM, Paulino AF, McGinn CJ, Baker LH, Cohen DS, Morris JS, Rees R, Sondak VK. Cutaneous angiosarcoma of the scalp: a multidisciplinary
    approach. Cancer. 2003 Oct 15;98(8):1716-26. doi: 10.1002/cncr.11667. PMID: 14534889. Available from:
  8. Wu J, Li X, Liu X. Epithelioid angiosarcoma: a clinicopathological study of 16 Chinese cases. Int J Clin Exp Pathol. 2015 Apr 1;8(4):3901-9. PMID:
    26097574; PMCID: PMC4466961. Available from:
  9. Von Mehren M, Kane JM, Bui MM, Choy E, Connelly M, Dry S, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Meyer C, Pappo AS, Parkes AM, Paz IB, Petersen IA, Poppe M, Riedel RF, Rubin B, Schuetze S, Shabason J, Sicklick JK, Spraker MB, Zimel M, Bergman MA, George GV. NCCN Guidelines Insights: Soft Tissue Sarcoma, Version 1.2021. J Natl Compr Canc Netw. 2020 Dec 2;18(12):1604-1612. doi: 10.6004/jnccn.2020.0058. PMID: 33285515. Available from:
  10. Fujisawa Y, Yoshino K, Fujimura T, Nakamura Y, Okiyama N, Ishitsuka Y, Watanabe R, Fujimoto M. Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor. Front Oncol. 2018 Mar 2;8:46. doi: 10.3389/fonc.2018.00046. PMID: 29552543; PMCID: PMC5840142. Available from:

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Angiosarcoma of the scalp in a 79-year-old male: A case report