Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma

Abstract

Background: Cutaneous angiosarcomas are rare, aggressive tumors with high recurrence and poor prognosis. We share our experiences with the challenging surgical management of these lesions, focusing on both ablative and reconstructive outcomes. Methods: Retrospective cross-sectional chart review was conducted of patients diagnosed with scalp cutaneous angiosarcoma between 2005 and 2021. Resectability, defect reconstruction, and survival outcomes were analyzed. Results: Thirty patients were included, 27 (90%) men and three (10%) women, with a mean age at diagnosis of 71.77 ± 7.3 years, and mean follow-up of 429.43 ± 305.6 days. Only 12 patients completed their regular follow-up, while the remaining patients died. There was a median survival of 443.50 days (range, 42-1283) and median time to recurrence of 21 days (range, 30-1690). Multimodal therapy compared with surgery alone had a significantly better overall median survival (468 days versus 71 days; P = 0.021). Defect coverage was obtained in 24 cases (75%) through an anterolateral thigh flap, two patients (6%) with a local transposition flap, and one patient (3%) with a transverse rectus abdominis myocutaneous flap. The remaining three patients received a skin graft. All of the flaps survived, with one requiring a vein graft for venous congestion. Conclusions: Timely multimodal therapy with a histologically safe margin, combined with adjuvant therapy, improves survival and delays recurrence and metastasis, in cutaneous angiosarcoma patients. An anterolateral thigh flap facilitates the coverage of wide defects. Further investigations of advanced treatment modalities such as immunotherapy and/or gene therapy are required to deal with this highly aggressive tumor.

Leveraging the outcome of a frontal bone tumor facial reconstruction case by a multimodal approach

“…A multimodal approach to chronic or complex conditions deals with risk assessment, classification and systematization of problems, diagnosis, non-invasive and surgical treatment, lifestyle changes, and management of psychosocial factors. It is striking that a review of the literature pertaining to congenital, traumatic or oncological facial defects indicates that multimodality is frequently reflected by emphasizing imaging of defects; sequencing chemotherapy, immunotherapy or radiotherapy; or application of multiple tissue flaps for reconstruction – which is somewhat incomplete [ 1 ]. “Longitudinality” of problems as well as final stages of reconstruction requiring restoration of aesthetics and dignity are rarely addressed, or are the subject of separate studies [ 2–4 ].…”

Reconstruction of extensive scalp defects of oncologic origin using thoracodorsal artery perforator free flaps

“…However, malignant neoplasms of the scalp require a certain extent of resection with safety margins along the tumor perimeter; this results in extensive, bony, and deep defects [3]. In such cases, microsurgical reconstruction with a free tissue transfer has been the first choice for preserving the recipient-site structure and function and for ensuring aesthetic outcomes, even though it is technically more difficult and challenging than alternatives such as skin grafting and local flap transfer [4][5][6][7][8].…”