What causes angiosarcoma of the scalp?

Updated: Jan 03, 2020
  • Author: Jonathan S Zager, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

Answer

The cause of angiosarcoma of the scalp is unknown, although several associations have been reported. Angiosarcoma developing in persons with chronic lymphedema is well described. However, lymph stasis is probably not involved significantly in angiosarcoma of the scalp. The most frequent association with angiosarcoma of the scalp is prior radiation for either a malignant or a benign condition. The mechanism for radiation-induced angiosarcoma is unknown. Radiation-induced angiosarcoma typically presents 5-10 years after irradiation, while radiation-induced tumors of the head and neck have shown greater latency periods. [8] Perez et al found radiation-induced angiosarcoma of the breast to occur at a median of 9 years, while head and neck angiosarcoma occurred at 15 years. [1] Interestingly, according to Lydiatt et al, the histologic appearance and clinical behavior in postirradiation tumors do not appear significantly different from those in tumors arising de novo. [9]

Other risk factors described for angiosarcoma at other locations include exposure to vinyl chloride and thorium dioxide (Thorotrast). Because most angiosarcoma occurs on the scalp and face of whites and usually in non–hair-bearing areas, ultraviolet light exposure has also been suggested as a contributing cause. However, Lydiatt et al investigated the prevalence of metachronous skin cancers as an expression of solar damage and found that only 3 of 18 patients had a history of basal or squamous skin cancer. [9] This is consistent with the prevalence in the general population for this age group and does not support solar exposure as a significant agent. Holden et al questioned sun exposure as a tumorigenic agent because many patients who develop angiosarcoma are women with a full head of hair. [10] Finally, Lydiatt et al suggested trauma as a causative agent, but trauma seems more likely to just be the reason the lesion is noticed by the patient. [9]


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