Cutaneous Angiosarcoma in a Patient with Chronic Lymphedema: A Case Emphasizing the Importance of Early Recognition

We report the case of a 78-year-old female with a history of radical mastectomy for breast cancer in 2011, complicated by chronic left upper extremity (LUE) lymphedema. In September 2021, she was referred to plastic surgery for evaluation of a progressively enlarging, violaceous lesion on the LUE. Initially presumed to be a slow-healing hematoma, the lesion continued to enlarge, prompting a skin biopsy three months later that confirmed a diagnosis of cutaneous angiosarcoma.The patient declined amputation but underwent multiple local resections, chemotherapy, and radiation therapy. In June 2024, nearly two years after her initial diagnosis, she presented to the emergency department with signs of a soft tissue infection of the LUE. Imaging and laboratory workup revealed no evidence of metastatic spread. During her hospitalization, she developed worsening infection, suffered multiple strokes, and became septic. After a transition to comfort care, she passed away the same day.Angiosarcoma, a rare and aggressive subtype of soft tissue sarcoma (STS), is associated with poor prognosis and a high rate of early metastasis, with 20–40% of patients presenting with metastatic disease at diagnosis. Median survival is approximately 2.5 years with intervention, compared to 5–8 months with palliative care alone. Surgical resection remains the gold standard for localized disease. This case underscores the importance of early recognition and biopsy of suspicious lesions, particularly in patients with chronic lymphedema, to facilitate timely diagnosis and potentially improve outcomes in STS.