Facial angiosarcoma: A unique, non-purpuric presentation with good prognosis and unconventional management.

Cutaneous angiosarcoma is a rare, aggressive malignant neoplasm of vascular endothelial cell origin with a poor prognosis. The typical presentation of cutaneous angiosarcoma involves a progressive, bruise-like lesion on the head or neck.1 We present an atypical case of facial angiosarcoma in a 79-year-old white male arising as an asymmetric, non-purpuric swelling of the left nasal tip and ala, resembling an asymmetric rhinophyma. Several studies comparing face and scalp angiosarcomas have shown improved prognosis when angiosarcoma occurs on the face.2 Our case supports this trend noted in the literature. Angiosarcoma is typically treated with multiple modalities including surgery, radiotherapy, and chemotherapy. Our patient’s angiosarcoma was controlled with debulking surgery, radiation therapy, and Pembrolizumab (off-label use of immunotherapy). Patient is doing well 4 years later and will resume surgery or radiation if needed for any recurrence.