Cutaneous Angiosarcoma of the Head, Neck, and Face of the Elderly in Type 5 Skin
A 65-year-old apparently healthy man was referred from the ophthalmology department and reported to us with a blackish swelling around his left eye of 1-month duration, associated with severe headache. He attributed it to the fall he had sustained 1-month prior to the onset of the swelling.\nThe lesions started as a papule over the left side of the scalp which started to bleed when the patient picked it and a few days later, he developed swelling around the left eye which was reddish and then turned black.\nThere was no history of fever, vomiting, loss of weight, or appetite.\nOn examining the patient's skin, a diffuse ill-defined dusky red, woody hard, hematoma-like swelling was noted around the left eye which extended up to the cheek. There was a marked edema of both eyelids, disabling the patient from opening his eyes [Figures and ].\nA reddish hue along with peau-de-orange appearance of skin of forehead was noted.\nOn the left parietal region of scalp, there was a solitary firm nodule with central ulceration (2 × 2 × 2 cm). Bluish red indurated plaques were present in the retro-auricular regions.\nHis general physical parameters were normal and all other systems were found to be within normal physiological limits.\nWe considered the provisional diagnoses of hematoma, cutaneous angiosarcoma of the head and neck of the elderly, and primary systemic amyloidosis.\nDuring the 2 weeks' time while under our supervision, we visualized the evolution of the swelling to the other half of the face.\nInvestigations included complete hemogram with erythrocyte sedimentation rate, blood sugar, renal parameters, chest X-ray, ultra sonography test abdomen, computed tomography scan of the head, Echocardiogram and all were within normal limits. Skin biopsy (punch) from a representative site over the left forehead showed features suggestive of hemangioma. A repeat excisional biopsy of the excoriated nodule over scalp turned out to be cutaneous angiosarcoma []. Immunohistochemical study was positive for CD31, CD34, and Ki67, thus confirming the initial diagnosis of a high-grade cutaneous angiosarcoma.\nThe patient was referred to a cancer institute where after appropriate discussion, he was started on radiation therapy. But the patient did not complete the treatment and was subsequently lost to follow-up.