This section is dedicated to Diane Tong, author, musician, friend.

TONG-Diane. Author and photographer. Beloved daughter of Beatrice and Harold Deitchman. Sister of Robert Deitchman. 1998

Original Article

Cutaneous angiosarcoma of the scalp A multidisciplinary approach

Timothy M. Pawlik, M.D., M.P.H. 1, Augusto F. Paulino, M.D. 2, Cornelius J. Mcginn, M.D. 3, Laurence H. Baker, D.O. 4, Deborah S. Cohen, M.S. 5, Jeffery S. Morris, Ph.D. 5, Riley Rees, M.D. 1, Vernon K. Sondak, M.D. 1 *

1Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 2Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 3Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 4Department of Medical Oncology, University of Michigan Medical School, Ann Arbor, Michigan 5Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

email: Vernon K. Sondak (

*Correspondence to Vernon K. Sondak, The University of Michigan Hospitals, 3306 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0932

Fax: (734) 647-9647



Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor.


Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed. Analysis was performed to assess for factors impacting time to recurrence and survival.


The study was comprised of 29 patients with a median age of 71.0 years. Most patients presented after a delay in diagnosis with either a bruise-like macule (48.3%) or a nonbruise-like nodule (51.7%).

Seventy-five percent of patients had pathologic Stage T2 disease, and 76% of patients had high-grade tumors. Virtually all patients underwent surgical excision (96.6%); however, negative surgical margins were achieved in only 21.4% of patients.

Multiple lesions on presentation were associated with a shorter time to recurrence (P = 0.02). The median actuarial survival was 28.4 months. Younger patients and patients with Stage T1 disease had improved survival (P = 0.024 and P = 0.013, respectively).

Radiation therapy was associated significantly with a decreased chance of death (hazard ratio, 0.16; P = 0.006).


Although surgery remains the first option for the treatment of patients with angiosarcoma of the scalp, achieving negative margins often is impossible.

Patients who are younger and who have less extensive disease fare better. Postoperative radiation therapy should be employed routinely, as it may lead to improved survival.

Cancer 2003. Volume 98, Issue 8 , Pages 1716 - 1726

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