Introduction: Angiosarcoma is a rare head and neck sarcoma of vascular endothelial cell origin. We report a case of angiosar- coma in an elderly male, and the multidisciplinary approach employed in his treatment. Case report: A 79-year-old male presented with a 4-month history of a rapidly enlarging black, soft, immovable tumor surround- ed by bruise-like patches over the right temporoparietal scalp. There was associated pruritus and bleeding when scratched. Dermoscopy showed bluish black crusts over the tumor, and surrounding violaceous patches. Wedge biopsy revealed a dermis with irregular vascular spaces infiltrating dermis, lined by atypical endothelial cells. Immunohistochemistry of the atypical in- filtrative cells was positive for CD31. These findings were consistent with angiosarcoma. The patient underwent wide excision with a rotational flap and split thickness skin graft. Postoperatively, the patient was referred to Oncology for adjuvant radiation therapy. Conclusion Even with treatment, the prognosis of angiosarcoma remains poor due to its aggressive nature, with a 5-year sur- vival rate ranging from 10-54%. However, early detection of the disease may increase patient survival rates. This rare case shows the importance of maintaining a high level of suspicion for lesions that have an atypical presentation to prevent delays in man- agement and improve patient outcomes.
Hemangiosarcoma ; Scalp ; Neoplasms

Introduction: Psoriasis and some of its treatments such as methotrexate have been linked to the development of non-melanoma skin cancers including cutaneous squamous cell carcinoma (SCC). Chronic maque psoriasis, Koebnerization, and prolonged methotrexate therapy are some of the concerns that may impact wound healing and graft uptake when treating these patients. Case Report: We report a case of a 64-year-old male with a 32-year history of moderate to severe psoriasis continuously self-medicating with methotrexate for 30 years who presented with a solitary indurated tumor with ulceration on the right anterior leg. Histopathology result revealed acantholytic cSCC. The patient concomitantly has generalized psoriatic plaques that complicated the selection of donor site for the skin graft, and raised concerns on wound healing and graft uptake. He underwent wide excision surgery with gastrocnemius (medial head) flap and split thickness skin graft. Platelet-rich plasma (PRP) injections were utilized post-operatively to increase graft survival and donor site regeneration. Discussion The main risk factors for the development of cSCC for this patient are the history of chronic plaque psoriasis and chronic methotrexate therapy. These two can also complicate the success of grafting and wound healing for this patient. PRP was utilized to for better graft survival, faster wound healing, and prevention of Koebnerization.
Platelet-Rich Plasma ; Neoplasms, Squamous Cell ; Psoriasis ; Methotrexate