Diffuse Cutaneous Angiosarcoma Involving Scalp and Face on 18F-FDG and 68Ga-NODAGA-RGD PET/CT

Cutaneous angiosarcoma of the scalp is a rare, highly aggressive malignant tumor. A 67-year-old man with initial presentation of intermittent facial puffiness, periorbital swelling, and a gradually increasing painless ulcerative lesion on the right side of his forehead, and biopsy-proven cutaneous angiosarcoma, underwent 18 F-FDG-PET/CT for initial staging. FDG-PET/CT demonstrated increased tracer uptake in the scalp and facial regions, encompassing periorbital and perinasal areas. 68 Ga-NODAGA-RGD-PET/CT (imaging marker of increased angiogenesis) revealed enhanced uptake at the same regions, without evidence of bone or brain parenchyma involvement. Unlike FDG, 68 Ga-NODAGA-RGD, with no physiological uptake in the brain, demonstrates promise as an advanced diagnostic and treatment-monitoring tool for evaluation of scalp/brain involvement.