Ayser DUYAN, Pelin HIZLI, Arzu KILIÇ, Özge ÖZMEN, Gülay TURAN
Turkish Journal of Dermatology - 2026;20(3):146-149
Cutaneous angiosarcoma is a rare and aggressive malignant tumor of vascular endothelial origin that most commonly affects the scalp of elderly individuals and may clinically mimic benign or inflammatory dermatoses, leading to delayed diagnosis. We report the case of an 85-year-old man who presented with a three-month history of a progressively enlarging, painful lesion on the right parietal region of the scalp, which had initially been misdiagnosed as herpes zoster-associated cervical trophic syndrome. Dermatological examination revealed a 13 x 9 cm violaceous plaque with ulceration and yellow crusting. Dermoscopy demonstrated red clods and irregular red-violaceous structureless areas. Cytologic examination using a Tzanck smear showed atypical spindle cells with hyperchromatic nuclei and prominent nucleoli, suggestive of a vascular malignancy. Histopathological evaluation confirmed the diagnosis of cutaneous angiosarcoma, and immunohistochemical staining was positive for ERG, CD31, and CD34 but negative for EMA, CK5/6, HHV8, and BerEP4. Head computed tomography revealed no evidence of metastasis or calvarial invasion. The patient was referred to oncology; however, the patient was referred to oncology; however, systemic chemotherapy was not initiated because of advanced age; surgical excision with consideration of adjuvant radiotherapy was planned. This case highlights that cutaneous angiosarcoma may clinically mimic herpes zoster-related conditions and emphasizes the importance of dermoscopy, cytology, and histopathology in the early diagnosis of atypical scalp lesions.
