Subtle Facial Angiosarcoma

presented by

David Elpern M.D.

Williamstown, MA, USA

June 11, 2009


Abstract 83 yo man with a new lesion
83 yo man
2 months
root of nose

This 83 year-old retired college professor presented for a semi-annual skin exam.  He has a history of basal cell carcinoma.  For the past two months, the patient has noted a new lesion near the root of the nose on the left nasal side-wall.

Physical Examination

There is a five mm flesh colored papule in the above-mentioned area.  Other than nodular elastosis with comedones and cysts the exam is unremarkable.

Photo:  Shows a subtle lesion without diagnostic features.  Dermoscopically it had no salient findings.



Laboratory Data



Biopsy shows a diffuse superficial and mid-dermal proliferation of angular and irregular vascular spaces, lined with hyperchromatic and protruding epethelial cells and more deeply by epitheloid cells with large nuclei and prominent nucleoli. 

Immunoperoxidase staining is positive for CD-31 and negative for high and low molecular weight keratins, S-100 and Mart-1/Melanin-A.


10x superficial

40x deep epithelioid

20x cd-31 marker




The patient is having CT of abdomen and chest and MRI of head and neck.  He has been referred to a micrographic surgeon.


What would be appropriate therapy?
Is there any role for sentinal lymph node biopsy?
What kind of adjuvant radiotherapy should be used?

References 1.  de Keizer RJ, de Wolff-Rouendaal D, Nooy MA.  Orbit. 2008;27(1):5-12. 
Angiosarcoma of the eyelid and periorbital region. Experience in Leiden with
iridium192 brachytherapy and low-dose doxorubicin chemotherapy.

Department of Opthalmology, Leiden University Medical Center, Leiden, The

AIM: To report on the use of iridium(192) brachytherapy and doxorubicin
chemotherapy as adjuvant therapy in 6 patients with angiosarcoma of the eyelid
and periorbital region. MATERIAL AND METHODS: Tumor localization and diameter,
signs of inflammation, histology and treatment are discussed in this
retrospective study of 6 patients (age 46-87 yrs.) presenting with primary
angiosarcoma in the eyelid. RESULTS: Six patients (4 elderly) with angiosarcoma
localized in one or more eyelids, the face or multilocular were seen between 1987
and 2000. In one patient, a small nodular tumor did not recur within 4 years
after radical excision. In another patient, the tumor was treated with surgery
and iridium(192) wire brachytherapy and did not recur in 17 years of follow-up.
In four patients with large diffuse tumors that were treated with doxorubicin,
partial regression was achieved. The follow-up was >3 years (median 5 years).
CONCLUSION: If radical surgery for angiosarcoma of the eyelid and periorbital
region is not possible, adjuvant iridium(192) wire brachytherapy may prove
beneficial. For widespread, diffusely growing tumors, and in elderly patients,
low-dose (slowly, 20 mg i.v.) doxorubicin can be used weekly as adjuvant therapy,
resulting in partial regression and longer survival rates than previously
published by other authors.

2.  Mitra A, Ramnath R, Nicholson S, Yung A.  Clin Exp Dermatol. 2008 Jan;33(1):87-9. Epub 2007 May 14.   An erythematous nodule on the eyelid.
Department of Dermatology, Leeds General Infirmary, Leeds, UK.  We can send a pdf of this to anyone who wants ti read this.


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