Clinical, dermoscopic and histopathological features of spontaneous scalp or face and radiotherapy-induced angiosarcoma

Dermoscopic pattern of radiation-induced angiosarcoma (RIA)

“…RIA is a known late-onset side effect of radiotherapy, presenting as single or multiple ecchymotic macular or pink-purplish papular cutaneous lesions, years after radiotherapy in the radiation field. 1 De Giorgi et al 2 described pink-purple ''steam-like areas'' with a white or skin-colored central area and a strengthening of the purple color at the periphery of the lesions under dermoscopic examination. In fact, RIA present the classic colors of vascular lesions under dermoscopy, namely a gradation of red, purple, and blue color.…”

Blue Lesions

“…11). 44 Dermoscopy can raise further suspicion of angiosarcoma, because dermoscopic criteria that are specific for benign vascular proliferations, such as the presence of discrete lacunae, are absent. This is particularly evident in cases where the clinical scenario is also suspicious for angiosarcoma, typically an enlarging violaceous plaque or nodule preferentially located on the scalp of an elderly man.…”

Cutaneous angiosarcoma: the role of dermoscopy to reduce the risk of a delayed diagnosis

“…Clinical aspects of CA may be subtle and difficult to identify especially for a nondermatologist, as in our first case, appearing as a violaceous plaque or nodule mimicking different types of lesions: bruising, benign inflammatory disease, hemangiomas, tumid lupus, or cellulitis …”

“…Cutaneous angiosarcoma is a rare, aggressive malignant vascular tumor classified into: (i) sporadic angiosarcoma of the scalp and face; (ii) lymphedema‐associated angiosarcoma as secondary to chronic lymphedema (Stewart–Treves syndrome); (iii) radiation‐induced angiosarcoma (RIA), a rare complication of radiotherapy with a wide interval range between radiation and the diagnosis of 6 years …”