Dermoscopic pattern of radiation-induced angiosarcoma (RIA)

Angiosarcoma of the Auricle in a Patient with Xeroderma Pigmentosum Variant

Xeroderma pigmentosum (XP) is an inherited autosomal recessive disorder characterized by photosensitivity and an increased risk of developing multiple skin neoplasms at sites exposed to the sun. We report a 73-year-old Japanese man with angiosarcoma of the auricle and an XP-variant, which is a very rare condition. In this case, long-term physical stimulation due to auricular deformation after surgery may have been the cause. Angiosarcoma associated with XP has a better prognosis than common angiosarcoma, perhaps because of the smaller tumor size. As XP patients are at high risk of skin neoplasms, they consult dermatologists regularly, and therefore skin tumors are likely to be detected early.

Primary and secondary cutaneous angiosarcoma: Distinctive clinical, pathological and molecular features

Angiosarcomas are ubiquitous neoplasms involving both cutaneous and soft tissue and visceral locations. Accumulating biomolecular evidences suggest that cutaneous angiosarcomas are distinctive entities with molecular, clinical and pathological peculiarities. Despite several ongoing clinical trials with promising therapeutic agents, the prognosis of cutaneous angiosarcomas is dismal and survival still rely on early diagnosis and surgery. An accurate diagnosis and the knowledge of the underlying molecular landscape are therefore essential to improve the prognosis. We detail the molecular, clinical, dermoscopic, morphological and prognostic features of cutaneous angiosarcoma. Although the molecular landscape of cutaneous angiosarcoma is not completely understood, accumulating evidences suggest that there are characteristic molecular alterations including dysregulation of angiogenesis and several complex molecular pathways. Secondary cutaneous angiosarcomas, arising in correlation with chronic lymphedema and ionizing radiation, have different molecular hallmarks, which are also leading to the first diagnostic applications. The diagnosis of cutaneous angiosarcoma may be challenging, as well-differentiated forms can be hard to distinguish from benign and low-grade vascular neoplasms, while poorly differentiated forms can be easily confounded with other non-vascular high-grade neoplasms. An accurate and early diagnosis, which is mandatory to ensure the best survival for the patients, is mainly based on morphological hallmarks.

Dermoscopy in a lymphangiosarcoma of Stewart–Treves syndrome

Stewart–Treves syndrome is a rare invasive lymphangiosarcoma linked with chronic lymphedema after mastectomy for breast cancer. Given the aggressive nature of the tumor, preventative measures and early diagnosis are important. This case is the first dermoscopic description of the lymphangiosarcoma of Stewart–Treves syndrome; it shares similar dermoscopic findings with angiosarcoma of the scalp after irradiation, with findings of a pink-white background, white lines and a combination of red, blue and black structureless areas containing red dots and globules. The lack of conspicuous lacunae make dermoscopy useful for ruling out other differentials such as benign vascular proliferations. Color heterogeneity and vascularization in dermoscopy might inform the clinician of a high percentage of tumor cells on histology.