Background: We set out to examine clinicopathologic variables for cutaneous head and neck angiosarcoma including whether outcomes were worse for the scalp.

Methods: Retrospective outcomes analysis of all 57 patients identified from the Princess Margaret Cancer Centre Registry (1958-2014).

Results: Median follow-up was 1.6 years.  Median survival was 24 months (95%CI, 16-32 months).  For scalp and face respectively, five-year locoregional control was 8% and 51% (P=0.01), relapse-free survival 4% and 26% (P=0.006) (Fig. 1), and overall survival 8% and 25% (P=0.004).  Scalp lesions were larger, more likely to be multifocal and recognized for a shorter time pre-diagnosis.  On Cox multivariate analysis, scalp site was independently prognostic for mortality (HR 2.3, 95%CI 1.2-4.4; P=0.02) as was ulceration; multifocality and ulceration were independently prognostic for locoregional failure.

Conclusion: Scalp angiosarcoma had much worse local control and survival than angiosarcoma of the face.  Scalp angiosarcoma may not be noticed by the patient until more advanced.

Fig. 1: Kaplan-Meier survival curves of actuarial five-year relapse-free survival for scalp (n = 32) and face (n = 25) angiosarcoma tumor sites (P = 0.006, Mantell-Cox).