Angiosarcoma of the scalp

Abstract

Angiosarcoma is a relatively rare soft tissue tumour. It usually occurs in the head and neck, and especially in the scalp, in elderly people. Its presentation varies from a small plaque to multifocal nodules. The treatment depends on the extent of the disease. Most cases are treated with wide excision with reconstruction. Radiotherapy and chemotherapy are advocated in the recurrent or extensive lesions with regional or distant metastasis. Other modalities such as immunomodulation have been tried. A case of a 55-year-old female patient with a bleeding scalp lesion is presented. Initially thought to be a pyogenic granuloma, on excisional biopsy it was diagnosed as angiosarcoma with microscopic involvement of the margins. Wide excision with reconstruction using a local rotation flap was done at a second stage. The patient was not given postoperative radiotherapy or chemotherapy. There has been no recurrence for two years.

Cutaneous angiosarcoma of the head, neck, and face of the elderly in type 5 skin

“…[16] Our patient had a history of fall from his bicycle prior to the onset of the lesion. Trauma was involved in 27% of patients in a case series.…”

Fulminant course of angiosarcoma of the scalp on multimodal therapy with paclitaxel, bevacizumab, and radiation

“…Cutaneous angiosarcomas are characterized by marked clinical variability, which may delay diagnosis and thus have detrimental effects on the disease course. The clinical spectrum ranges from persistent erythema, red/bluish papules, nodules or plaques, which may ulcerate over time, to cushion-like swellings as well as rosacea-or hematoma-like lesions [ 4,5 ] .…”

“…Administered in pegylated lipsomal form, the anthracycline doxorubicin achieves response rates of 17-34 % and can, in combination with ifosfamide, prolong the progression-free interval [ 3 ] . Various case reports and retrospective studies have shown high response rates for a taxane-based regimen using paclitaxel -this has also been attributed to the antiangiogenic effects of taxanes [ 1,2,4,8 ] . VEGF (vascular endothelial growth factor) plays a key role in the pathogenesis of angiosarcoma; in particular, there is a comparatively high expression of VEGF-A and its receptor.…”

Helical Tomotherapy® is a Safe and Feasible Technique for Total Scalp Irradiation

“…It can occur in any part of the body, most frequently in the head and neck region, especially the scalp in elderly patients. 1 Prognosis of angiosarcomas of the scalp is very poor given its high propensity to metastasize, with 5-year survival rates of 10-30% and a median overall survival of about 15 months.…”