Cutaneous Angiosarcoma of the Scalp Mimicking Facial Cellulitis

Abstract

Although patients with dermatologic diseases sometimes present at ENT clinics, few ENT specialists encounter cutaneous malignancies. The most common skin cancers of the head and neck are non-melanoma skin cancers (NMSC).1 These cancers are good mimics of inflammation. Herein we report the case of an 88-year-old man presenting with a 4-month history of progressive redness, swelling, and pain of the left face and neck (figure, A). Physical examination showed multiple lymphadenopathies over the left level II to V, with a fixed and elastic quality. Laboratory data revealed mild leukocytosis (10,640/μl), elevated C-reactive protein (6.01 mg/dl) and erythrocyte sedimentation rate (35 mm/hr), and hyperkalemia (6.0 meq/L). Because of our initial impression of left neck lymphadenitis with facial cellulitis, the patient was administered parenteral amoxicillin and clavulanic acid. Because this intervention did not resolve the complaint, the patient underwent magnetic resonance imaging (MRI), which showed skin thickening, septation of the subcutaneous fat, and thickening of the superficial fascia (figure, B). These features were consistent with lymphadenitis and cellulitis of the left face and neck. However, because the patient was afebrile, it was thought best to evaluate him further to rule out other diagnoses. Thus, an excisional biopsy of one lymph node from the left neck level III was performed. Pathology revealed irregular, anastomosing vascular structures lined by rhabdoid-featured, large, atypical cells with positive immunohistochemical stains for CD34 and CD31 (figure, C), indicating poorly differentiated angiosarcoma. A review of previous images led to the lesion’s finally being staged at T2N1M0. Chemoradiotherapy was recommended rather than extensive surgery because the patient was elderly and the tumor was diffuse. However, the patient declined