Diagnosis, treatment, and prognosis of scalp angiosarcoma: A case report

Rationale: Scalp angiosarcoma is a rare malignant vascular tumor with the characteristics of occult early symptoms, no specificity, a high misdiagnosis rate, strong invasion, and poor prognosis. The 5-year survival rate is <30%. The accumulation of rare cases is of great significance for optimizing diagnosis and treatment. Patient concerns: A 78-year-old man presented with a dark-brown nodule on the top of the head 2 months ago, which progressively enlarged with ulceration, erosion, and easy bleeding. Topical antibiotic therapy was ineffective. Imaging showed a mass with an unclear inferior boundary and rich blood flow (without bone destruction). Dermoscopy showed invasive growth with abnormal blood vessels. The diagnosis was confirmed by pathology and immunohistochemistry (positive for CD31, CD34, and ERG). Diagnoses: Angiosarcoma of the scalp was confirmed based on skin pathology and immunohistochemical results. Interventions: The scalp tumor was surgically removed under general anesthesia, and skin from the thigh was taken for transplantation. Outcomes: Skin necrosis and skull exposure in the graft area after the operation. The patient refused further repair treatment, imaging evaluation, radiotherapy, and chemotherapy, and died of massive hemoptysis 5 months after surgery. Lessons: Early identification and standardized comprehensive treatment are the core to improving prognosis. In clinical practice, it is necessary to accumulate rare cases, improve disease cognition, optimize diagnosis and treatment processes, and strengthen treatment compliance management to reduce mortality and improve quality of life.