Selective Transarterial Embolization for Refractory Bleeding in Advanced Scalp Angiosarcoma: Two Cases

Cutaneous angiosarcoma of the scalp is a highly aggressive vascular malignancy that predominantly affects elderly individuals and may cause severe tumor bleeding during disease progression. Hemorrhage from ulcerated tumors is often difficult to control, particularly in patients previously treated with chemoradiotherapy. We report two cases of advanced scalp angiosarcoma in which refractory tumor bleeding was successfully controlled by selective transarterial embolization. The first patient, a 75-year-old man with recurrent angiosarcoma of the frontal scalp region after multiple systemic therapies and radiotherapy, developed repeated arterial bleeding from ulcerated lesions requiring transfusion support. Angiography identified tumor-feeding branches of the superficial temporal artery and angular artery, and embolization achieved immediate hemostasis. A second embolization procedure was required for recurrent bleeding. The second patient, a 75-year-old woman, also developed persistent bleeding from a progressive scalp tumor despite chemoradiotherapy. Selective arterial embolization resulted in rapid and sustained bleeding control without major complications. These cases suggest that selective transarterial embolization may provide rapid control of refractory arterial tumor bleeding and reduce local treatment burden in selected patients with advanced scalp angiosarcoma.