Angiosarcoma Presenting as a Chronic Non-Healing Lower Extremity Ulcer in Lymphoedema: A Challenge

Cutaneous angiosarcoma is a rare and aggressive malignancy that may arise in chronic lymphoedema. Its presentation as a non-healing ulcer can lead to delayed diagnosis. We describe an atypical case of angiosarcoma presenting as a chronic lower extremity ulcer in the setting of chronic lymphoedema and to highlight the importance of early biopsy. We report on the clinical course, diagnostic evaluation, treatment, and outcome of a patient with chronic lymphoedema who developed a persistent ulcer. A 74-year-old woman with longstanding lower extremity lymphoedema developed a non-healing ulcer initially managed as cellulitis and venous ulceration. Due to failure of conservative therapy, biopsy was performed and revealed angiosarcoma. The patient underwent surgical resection and adjuvant radiotherapy, remaining disease-free for over 4 years before recurrence and eventual death. Malignancy should be considered in chronic non-healing ulcers, especially in the setting of longstanding lymphoedema. Early biopsy is essential to avoid delayed diagnosis and improve outcomes.