Angiosarcoma of the scalp in the elderly: a case series

Cutaneous angiosarcoma (AS) is a rare soft tissue malignancy that often mimics various dermatoses, leading to a delay in diagnosis. The rapid rate of progression portends a poor prognosis. We present three elderly patients who presented with rapidly progressing erythematous-purpuric plaques on the scalp. Detailed clinical and laboratory evaluation, including imaging, were performed. All the patients were diagnosed with AS of the scalp based on histopathology and immunohistochemistry. They underwent a combination of wide excision and chemotherapy, with varying degrees of improvement. One patient also exhibited Kasabach–Merritt syndrome, which was managed with platelet transfusions. This case series underscores the importance of early recognition and a high index of suspicion for AS in elderly patients presenting with purpuric/bruising skin lesions on the scalp. Timely diagnosis and appropriate surgical and medical interventions are crucial for improving outcomes. Recognition of Kasabach–Merritt syndrome is vital in patients presenting with thrombocytopenia or bleeding manifestations.