Cutaneous angiosarcoma in a super-morbidly obese patient (body mass index 106.7 kg/m2) highlighting diagnostic and therapeutic barriers in extreme obesity: a case report

BACKGROUND: With the rising prevalence of extreme obesity, healthcare systems are increasingly confronted with patients who exceed the physical limits of standard diagnostic and therapeutic infrastructure. When body habitus exceeds the physical limitations of imaging and procedural infrastructure, timely cancer staging and intervention may become impossible, directly impacting survival. CASE PRESENTATION: ) with chronic stage IV lymphedema of both lower limbs who presented with a rapidly enlarging, violaceous, ulcerated plaque on the left calf. Histopathology confirmed high-grade cutaneous angiosarcoma (Stewart-Treves syndrome). Standard staging with CT, MRI, and positron emission tomography (PET) was not feasible due to exceeding gantry and table limits at all accessible regional centers. Bedside wide local excision was performed, followed by urgent below-knee amputation for progressive necrosis. Postoperatively, the patient developed septic shock, hemothorax, respiratory failure, and dialysis-requiring acute kidney injury. MANAGEMENT AND OUTCOME: Despite aggressive multidisciplinary intensive care, including continuous renal replacement therapy, thoracic drainage, catecholamine support, and non-invasive ventilation, diagnostic and interventional escalation remained repeatedly limited by infrastructural constraints. Owing to refractory multi-organ failure and an infaust prognosis, treatment was de-escalated to comfort-focused care. The patient died on day 24 of admission. CONCLUSION: This case illustrates how extreme obesity not only predisposes to lymphangiosarcoma, but may also preclude access to basic oncologic standards such as staging and operability assessment. The case highlights a critical gap in healthcare infrastructure, where patients may be systematically excluded from standard diagnostic pathways. The absence of bariatric-capable imaging and procedural infrastructure directly contributed to a loss of curative options. Healthcare systems must urgently adapt to the rising prevalence of super-morbid obesity by ensuring size-inclusive resources, or risk systematic exclusion of an expanding vulnerable population.