# An Atypical Presentation of Cutaneous Angiosarcoma: A Diagnostic Challenge in an End-Stage Renal Disease Patient

## TL;DR

This case report describes a rare and aggressive skin cancer that presented atypically in a patient with kidney disease, highlighting the need for careful diagnosis.

## Contribution

The paper presents a unique case of angiosarcoma without traditional risk factors, emphasizing diagnostic challenges in similar patients.

## Key findings

- The patient's symptoms were initially mistaken for calciphylaxis due to her kidney disease history.
- The case suggests malignant transformation of chronic venous insufficiency as a possible cause.
- Angiosarcoma should be considered in the differential diagnosis of atypical skin lesions.

## Abstract

Angiosarcomas are rare and highly aggressive malignant vascular tumors that are associated with a very poor prognosis. The rarity of the disease, its variable clinical presentations, and differing pathophysiologic mechanisms make diagnosing angiosarcoma a challenge. This case report details a 75-year-old woman with an atypical presentation of cutaneous angiosarcoma in the absence of traditional risk factors. Due to the patient’s history of end-stage renal disease, her initial presentation was highly suspicious for cutaneous calciphylaxis of the left lower extremity. After a thorough workup, this patient likely had malignant transformation of her chronic venous insufficiency. This case underscores the necessity for healthcare providers to consider angiosarcoma in the differential diagnosis of atypical, persistent violaceous nodules and plaques, even in the absence of classic risk factors such as radiation exposure, chronic lymphedema, genetic syndromes, and certain linked carcinogens. A high index of suspicion, combined with timely diagnostic interventions, is vital to address this aggressive malignancy effectively.