Unusual Clinical Presentation of Cutaneous Angiosarcoma Masquerading as Eczema: A Case Report and Review of the Literature

An unusual case of cutaneous angiosarcoma clinically mimicking eczema is described. A 98-year-old Caucasian male presented with a 6-month history of a flesh-colored, subcutaneous nodule on his left forehead with contralateral facial erythema and scaling that had been previously diagnosed as eczema. Despite treatments with topical steroids and moisturizers, the condition did not resolve. At our clinic, excisional biopsy of the forehead lesion and scouting biopsies from the contralateral cheek were performed which revealed cutaneous angiosarcoma. The described case illustrates that dermatitis-like features should be considered as a rare clinical manifestation of cutaneous angiosarcoma. It also demonstrates that these lesions may respond well to radiotherapy as a single modality. 1. Introduction Angiosarcoma is a highly invasive tumor of vascular endothelial origin with poor prognosis and high rates of recurrences; therefore, early detection is essential to its treatment. The following case is reported because of the unusual clinical presentation of the malignant tumor in an elderly patient. 2. Case Report In early 2012, a 98-year-old robust Caucasian male presented to our clinic with a 6-month history of an enlarging flesh-colored nodule on his forehead. Following the development of this lesion, mildly pruritic red, scaly patches appeared on the right side of his face. A clinical diagnosis of eczema was rendered by an outside physician. For his presumed dermatitis, a course of therapy including topical hydrocortisone and moisturizers was prescribed. While he complied with the outlined regimen, his symptoms did not improve. On clinical examination, the patient was found to have a flesh-colored subcutaneous nodule measuring ？cm in diameter on his left forehead and poorly demarcated red, scaly patches which were most prominent on the right contralateral cheek (Figure 1). An excisional biopsy was performed, which revealed angiosarcoma with positive lateral and deep margins (Figure 2). Immunohistochemical stains showed that the tumor cells were positive for CD34 and CD31 and negative for S100, LCA, CK7, and CK20. A wider local excision was attempted; however, we were not able to achieve clear margins. The majority of the wound was closed primarily, but the central area was left to heal secondarily. Figure 1: Clinical presentation of the patient with angiosarcoma prior to treatment. Figure 2: The main tumor was bulky and composed of atypical and pleomorphic spindle cells with numerous mitotic figures (a). On the periphery of the tumor, areas of vessel formation