Angiosarcoma: hiding in plain sight

• Published in: Dermatology online journal Vol. 30; no. 2
• Main Authors: Nguyen, Tue F, Bambekova, Pavela G, Hivnor, Chad M, Siddiqui, Huma A, Owen, Joshua L
• Format: Journal Article
• Language: English
• Published: United States 15.04.2024
• Subjects: Aged, 80 and over; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - pathology; Hemangiosarcoma - diagnosis; Hemangiosarcoma - pathology; Humans; Immunohistochemistry; Male; Scalp - pathology; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology
• ISSN: 1087-2108; 1087-2108
• DOI: 10.5070/D330263590

Angiosarcoma is a rare, aggressive soft-tissue sarcoma of endothelial origin that necessitates early recognition, diagnosis, and treatment. The most commonly reported presentation consists of violaceous patches and plaques on the head and neck of elderly white men, with fewer reports affecting patients with Skin of Color. Most cases of angiosarcoma are idiopathic and tend to recur locally with early metastasis, conferring a poor prognosis. We report a case of an 83-year-old Fitzpatrick skin type IV man who presented with a large violaceous-to-black mamillated plaque on the frontotemporal scalp that was clinically highly suggestive of cutaneous angiosarcoma. However, unrevealing histopathology complicated our diagnostic process and delayed management. Immunohistochemistry was invaluable in determining the diagnosis of angiosarcoma. Our case highlights the aggressive nature of cutaneous angiosarcoma, necessitating close clinicopathologic correlation to confirm the diagnosis and initiate treatment.