An uncommon presentation of a cutaneous angiosarcoma

Area of Science:

• Oncology
• Dermatology
• Pathology

Background:

• Cutaneous angiosarcoma (cAS) is a rare, aggressive vascular tumor primarily affecting the head and neck.
• Delayed diagnosis is common due to insidious onset and varied presentations, leading to poor patient outcomes.

Observation:

• An 88-year-old woman presented with a persistent retro-auricular lesion initially mimicking a hematoma.
• Initial histopathology and imaging were inconclusive for malignancy, showing benign features with hemorrhage.
• Rapid lesion expansion prompted further biopsies, revealing MYC oncoprotein expression confirming angiosarcoma.

Findings:

• Immunohistochemistry, specifically MYC oncoprotein detection, was crucial in diagnosing angiosarcoma after initial misleading histology.
• The tumor's size and location precluded surgical resection, and radiotherapy yielded minimal response.

Implications:

• This case underscores the diagnostic difficulties in cutaneous angiosarcoma, where histology and imaging can be deceptive.
• Advanced immunohistochemical markers are vital for accurate cAS diagnosis.
• Treatment challenges in the head and neck region necessitate exploring alternative therapeutic strategies for advanced cAS.