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Review
. 2025 Feb 14;14(4):1278.
doi: 10.3390/jcm14041278.

Personalized Treatment for Scalp Angiosarcoma

Adriana Nicoleta Cristescu  1 , Ioana Dumitrescu  2 , Irina Tudose  3 , Cristina Beiu  1   4 , Ana-Maria Dumitrescu  5 , Liliana Gabriela Popa  1   4
Affiliations
Review

Personalized Treatment for Scalp Angiosarcoma

Adriana Nicoleta Cristescu et al. J Clin Med. .

Abstract

Cutaneous angiosarcoma is a rare and aggressive malignant tumor that originates from the endothelial cells of blood vessels or lymphatic vessels. More than half of cutaneous angiosarcoma cases occur in the head and neck regions, particularly on the scalp. However, due to its rarity, scalp angiosarcoma is often overlooked in clinical practice. The lack of distinctive symptoms usually delays the diagnosis and, implicitly, the initiation of appropriate treatment. The treatment of cutaneous angiosarcoma poses great challenges due to its multifocal occurrence and the frequent extensive microscopic spread. A personalized, multimodal therapeutic approach is essential for ensuring a favorable outcome, consisting of a wide surgical excision associated with adjuvant radiotherapy in localized tumors, concurrent adjuvant radiotherapy and chemotherapy, targeted treatments, or immunotherapy in advanced or metastatic diseases. The aim of this manuscript is to review the literature data regarding the individualized management of cutaneous angiosarcoma and to share our own experiences in the field. We wish to underscore the importance of considering cutaneous angiosarcoma in the differential diagnosis of scalp tumors, especially in patients with a history of scalp irradiation as early detection, accurate diagnosis, and a multidisciplinary, personalized management, including surgery with clear margins and adjuvant radiation therapy, are crucial for ensuring a favorable outcome.

Keywords: angiosarcoma; radiotherapy; scalp; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Poorly demarcated erythematous-violaceous plaque (A), with yellow-greenish areas with irregular margins (B), infiltrated in places with violaceous nodules on the surface affecting the fronto-parietal scalp region (C).
Figure 2
Figure 2
Dermoscopic aspect of the tumor, showing yellow, red, and purple structureless areas (A,B) with yellow clods (C), occasionally covered with interlaced white lines, dark purple and blue nodules (D).
Figure 3
Figure 3
Hematoxylin-eosin stain showing a tumor with sclero-hyaline stroma that includes atypical spindle-shaped/elongated cells infiltrating focally among adipose lobules ((A), 40×), formation of papillary structures with a fibrous core lined by pleomorphic endothelial cells, ((B), 100×), and atypical vascular proliferation composed of irregularly dilated and anastomosed vascular spaces, lined by pleomorphic endothelial cells ((C), 200× and (D), 400×).
Figure 4
Figure 4
Immunohistochemical stains showing positivity for ERG ((A), 40×) and FLI1 ((B), 200×), as well as positivity for Ki67 in approximately 40% of tumor cells nuclei ((C,D) 200×).
Figure 5
Figure 5
Post-operative aspect 5 days (A), 2 weeks (B) and 6 weeks (C) after the surgical intervention.
See this image and copyright information in PMC

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