Angiosarcoma of the scalp

Cutaneous angiosarcoma of the scalp is a rare malignant neoplasm of endothelial cells which occurs predominantly in elderly Caucasian males. The etiology is unknown; however the most common association is prior radiation exposure. The diagnosis is often delayed due to misinterpretation for other lesions, including trauma-related bruising and infectious processes such as abscess. Radiologic imaging is non-diagnostic but can be helpful in defining the extent of local disease, as well as distant metastases. Prognosis is poor with a five-year survival rate of less than 30 percent. Treatment guidelines are not well established; however the mainstay is surgical resection with wide margins followed by adjuvant radiation therapy. Prognosis remains poor with a local recurrence rate of greater than 80 percent. Adjuvant chemotherapy is also controversial but may play a role in short term palliation of metastatic or locally advanced disease. Current investigations using molecular targeted therapy are underway with the goal of eliminating systemic side effects.