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|Comments from Faculty and Members
Ron Yaar MD, PhD, Assistant Professor, Director of Dermatopathology Training, Boston Medical Centre, Department of Dermatology, Dermatopathology Section, Boston, MA, USA on October 26, 2010
We all agree that this looks like the entity described variably as atypical vascular lesion of irradiated skin or benign lymphangiomatous papules.
I've attached some literature I found regarding this diagnosis. While relatively few cases have been described, it appears that the consensus is that these appear to behave in a benign fashion and do not represent precursors for angiosarcoma. (For further reference see presentation above )
Samuel Moschella MD, Professor of Dermatology, Emeritus, Harvard Medical School, Senior Consultant, Lahey Clinic, Burlington, MA, USA on October 28, 2010
I am aware of the disease and have heard discussions and the consensus about therapy was a trial with imiquimod (ALDARA).
Khaled El-hoshy M.D., Consultant Dermatologist, Troy, Michigan, USA on October 28, 2010
I would definitely re-biopsy another lesion in 1 month or so & keep a very close f/u. Angiosarcoma, or even metastatic breast CA, is a real possibility. I am not in favor of Imiquimod. I think it is a weak agent in such a case.
Bashir Zendah MD, Senior Registrar, Department of Dermatology, Tripoli Medical Centre, Tripoli, Libya on October 28, 2010
I agree with the opinion of Dr. Khaled because the spectrum of postradiation vascular lesions is wide and ranges from atypical vascular lesions with reportedly benign clinical behaviour to frank cutaneous angiosarcoma. There is, however, significant clinical as well as histological overlap. It is frequently difficult to classify these postradiation vascular lesions accurately and they create an emerging diagnostic and therapeutic challenge to both pathologists and clinicians. Experience with these vascular lesions is very limited.
Adel Aly MD, Dermatologist, Cairo, Egypt on October 29, 2010
I doubt imiquimod would work for a vascular lesion with malignant potential. From the review of literature it appears that cases developing into post-radiation angiosarcoma are older in age, having vascular type and larger size of the lesion (7.5 cm). Current recommendations include complete excision and f/u for any new lesion.