Low-grade dermal angiosarcoma of the breast following radiotherapy

Dermal angiosarcoma is a rare complication of radiotherapy. It is characterized by an aggressive nature and is distinct from other forms of angiosarcoma in that it does not always present with chronic lymphedema. A few case reports have appeared of cutaneous angiosarcoma arising in women previously treated with breast-conserving treatment and radiation for breast cancer. A review of the literature reveals that these lesions are difficult to diagnose because of their rarity and their highly variable and benign appearance, which may mimic radiation-induced changes in the skin. The majority of the literature reports describe high-grade lesions; only one case of low-grade angiosarcoma was described. We now report a second case of low-grade angiosarcoma arising 10 years after segmental mastectomy, axillary lymph node dissection, and radiation treatment for infiltrating ductal carcinoma. The prompt diagnosis of dermal angiosarcoma is strongly dependent upon a high index of suspicion. Biopsy should be considered in patients who present with new skin lesions after radiation treatment for breast cancer.