An Extensive Presentation of Cutaneous Angiosarcoma

August 2021 | Volume 20 | Issue 8 | Case Reports | 895 | Copyright © August 2021


Published online July 30, 2021

Carolyn G. Ahlers BSa, Jeffrey P. Zwerner MD PhDb, Eva Rawlings Parker MDb

aVanderbilt University School of Medicine, Nashville, TN
bVanderbilt University Medical Center, Nashville, TN

Abstract
In this report, the case of a 58-year-old male with extensive, rapidly growing cutaneous angiosarcoma is described. Though involvement of the scalp is common in cutaneous angiosarcoma, the extent of cutaneous disease at presentation in this case was striking. This case provides an important illustration of extensive cutaneous angiosarcoma of the scalp and its potential to rapidly advance. Early diagnosis and treatment of cutaneous angiosarcoma is paramount, as cutaneous angiosarcoma is highly aggressive and is associated with an overall poor prognosis. This case is presented to highlight the need for clinicians to maintain a high index of suspicion and low threshold for biopsy in patients presenting with violaceous or ecchymotic lesions on the head or scalp.

J Drugs Dermatol. 2021;20(8):895-897. doi:10.36849/JDD.6051

CASE REPORT

A58-year-old male with multiple medical problems, including a 15 year history of idiopathic thrombocytopenia (ITP), presented with violaceous lesions on the scalp and upper face. The patient initially noticed bruise-like patches on his scalp but discounted these as a reaction to a hair styling product. When the lesions did not improve, he sought evaluation by his internist who attributed the lesions to trauma in the setting of underlying ITP or a latex-related reaction to the straps on his continuous positive airway pressure mask. The patches progressively increased in size, prompting referral to dermatology four months after initial presentation. The patient denied pain, bleeding, itching, and constitutional symptoms. On physical examination, a 3 cm indurated, deeply violaceous vascular plaque with scant scale was noted on the right temple with adjacent violaceous, satellite lesions on the right lateral forehead (Figure 1). Surrounding these lesions were large, confluent violaceous patches extending onto the right temporal, frontal, parietal, vertex, and superior occipital scalp (Figures 2, 3, 4). Small violaceous macules were scattered on the forehead with prominent bilateral periocular edema (Figure 1 and 2). No lymphadenopathy was palpable in the cervical chains or supraclavicular basins.