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Dermatology

Cutaneous Angiosarcoma

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1 Credit CME

JAMA Dermatology

Published Online: January 18, 2023

Images in Dermatology

Article Information and Disclosures

Jason C. Klein, MD, PhD¹;

Arturo R. Dominguez, MD¹

Author Affiliations

¹Department of Dermatology, University of Texas Southwestern Medical Center, Dallas

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A Latin American woman in her 50s with a history of breast cancer status post lumpectomy and adjuvant radiation therapy presented with a 3-month history of a right neck nodule and purpuric rash on her right cheek. The growing nodule and rash were thought to be lymphadenopathy by an outside clinician before she presented to our dermatology clinic 3 months later. She endorsed progressive swelling around the right eye but denied systemic symptoms. Physical examination revealed a large, purpuric plaque involving most of her right face with associated periorbital swelling but without ulceration. Two punch biopsy specimens demonstrated a proliferation of vessels lined by CD31⁺, D2⁻40⁺, MYC⁺, and HHV8⁻ atypical crowded endothelial cells, which was consistent with angiosarcoma. Imaging results demonstrated tumor involvement of the orbit, fascia, and platysmas and suggested pulmonary, pleural, osseous, and nodal metastases.

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Article Information

Corresponding Author: Arturo R. Dominguez, MD, Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, Ste 400, Dallas, TX 75390-9191 (arturo.dominguez@utsouthwestern.edu).

Published Online: January 18, 2023. doi:10.1001/jamadermatol.2022.5446

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information. We also thank Heather Goff, MD, and Rebecca Vasquez, MD, University of Texas Southwestern Medical Center, for their insights on this case, for which they were not compensated.

References

Heinhuis KM , IJzerman NS , Koenen AM , et al. PropAngio study protocol: a neoadjuvant trial on the efficacy of propranolol monotherapy in cutaneous angiosarcoma-a proof of principle study. BMJ Open. 2020;10(9):e039449.PubMed Google Scholar

von Mehren M , Kane JM , Agulnik M , et al. Soft tissue sarcoma, version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(7):815-833.PubMed Google Scholar Crossref

Chow W , Amaya CN , Rains S , Chow M , Dickerson EB , Bryan BA . Growth attenuation of cutaneous angiosarcoma with propranolol-mediated β-blockade. JAMA Dermatol. 2015;151(11):1226-1229.PubMed Google Scholar Crossref

Albores-Saavedra J , Schwartz AM , Henson DE , et al. Cutaneous angiosarcoma: analysis of 434 cases from the Surveillance, Epidemiology, and End Results Program, 1973-2007. Ann Diagn Pathol. 2011;15(2):93-97.PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.