Cutaneous angiosarcoma of the scalp: A multidisciplinary approach

Timothy M. Pawlik, Augusto F. Paulino, Cornelius J. McGinn, Laurence H. Baker, Deborah S. Cohen, Jeffery S. Morris, Riley Rees, Vernon K. Sondak

Research output: Contribution to journalArticle

199 Citations (Scopus)

Abstract

BACKGROUND. Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor. METHODS. Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed. Analysis was performed to assess for factors impacting time to recurrence and survival. RESULTS. The study was comprised of 29 patients with a median age of 71.0 years. Most patients presented after a delay in diagnosis with either a bruise-like macule (48.3%) or a nonbruise-like nodule (51.7%). Seventy-five percent of patients had pathologic Stage T2 disease, and 76% of patients had high-grade tumors. Virtually all patients underwent surgical excision (96.6%); however, negative surgical margins were achieved in only 21. 4% of patients. Multiple lesions on presentation were associated with a shorter time to recurrence (P = 0.02). The median actuarial survival was 28.4 months. Younger patients and patients with Stage T1 disease had improved survival (P = 0.024 and P = 0.013, respectively). Radiation therapy was associated significantly with a decreased chance of death (hazard ratio, 0.16; P = 0.006). CONCLUSIONS. Although surgery remains the first option for the treatment of patients with angiosarcoma of the scalp, achieving negative margins often is impossible. Patients who are younger and who have less extensive disease fare better. Postoperative radiation therapy should be employed routinely, as it may lead to improved survival.

Original languageEnglish (US)
Pages (from-to)1716-1726
Number of pages11
JournalCancer
Volume98
Issue number8
DOIs
StatePublished - Oct 15 2003

Fingerprint

Hemangiosarcoma
Scalp
Skin
Survival
Radiotherapy
Recurrence
Neoplasms
Contusions
Neck
Endothelial Cells
Head

Keywords

  • Angiosarcoma
  • Radiation
  • Resection
  • Scalp

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Pawlik, T. M., Paulino, A. F., McGinn, C. J., Baker, L. H., Cohen, D. S., Morris, J. S., ... Sondak, V. K. (2003). Cutaneous angiosarcoma of the scalp: A multidisciplinary approach. Cancer, 98(8), 1716-1726. https://doi.org/10.1002/cncr.11667

Cutaneous angiosarcoma of the scalp : A multidisciplinary approach. / Pawlik, Timothy M.; Paulino, Augusto F.; McGinn, Cornelius J.; Baker, Laurence H.; Cohen, Deborah S.; Morris, Jeffery S.; Rees, Riley; Sondak, Vernon K.

In: Cancer, Vol. 98, No. 8, 15.10.2003, p. 1716-1726.

Research output: Contribution to journalArticle

Pawlik, TM, Paulino, AF, McGinn, CJ, Baker, LH, Cohen, DS, Morris, JS, Rees, R & Sondak, VK 2003, 'Cutaneous angiosarcoma of the scalp: A multidisciplinary approach', Cancer, vol. 98, no. 8, pp. 1716-1726. https://doi.org/10.1002/cncr.11667
Pawlik TM, Paulino AF, McGinn CJ, Baker LH, Cohen DS, Morris JS et al. Cutaneous angiosarcoma of the scalp: A multidisciplinary approach. Cancer. 2003 Oct 15;98(8):1716-1726. https://doi.org/10.1002/cncr.11667
Pawlik, Timothy M. ; Paulino, Augusto F. ; McGinn, Cornelius J. ; Baker, Laurence H. ; Cohen, Deborah S. ; Morris, Jeffery S. ; Rees, Riley ; Sondak, Vernon K. / Cutaneous angiosarcoma of the scalp : A multidisciplinary approach. In: Cancer. 2003 ; Vol. 98, No. 8. pp. 1716-1726.
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AB - BACKGROUND. Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor. METHODS. Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed. Analysis was performed to assess for factors impacting time to recurrence and survival. RESULTS. The study was comprised of 29 patients with a median age of 71.0 years. Most patients presented after a delay in diagnosis with either a bruise-like macule (48.3%) or a nonbruise-like nodule (51.7%). Seventy-five percent of patients had pathologic Stage T2 disease, and 76% of patients had high-grade tumors. Virtually all patients underwent surgical excision (96.6%); however, negative surgical margins were achieved in only 21. 4% of patients. Multiple lesions on presentation were associated with a shorter time to recurrence (P = 0.02). The median actuarial survival was 28.4 months. Younger patients and patients with Stage T1 disease had improved survival (P = 0.024 and P = 0.013, respectively). Radiation therapy was associated significantly with a decreased chance of death (hazard ratio, 0.16; P = 0.006). CONCLUSIONS. Although surgery remains the first option for the treatment of patients with angiosarcoma of the scalp, achieving negative margins often is impossible. Patients who are younger and who have less extensive disease fare better. Postoperative radiation therapy should be employed routinely, as it may lead to improved survival.

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