Perplexing Plaque on the Thigh of an Elderly Man

Cutaneous epithelioid angiosarcoma (CEA) is a rare, aggressive vascular neoplasm predominantly affecting elderly individuals. Due to its nonspecific clinical presentation, early diagnosis can be challenging yet crucial for prognosis. We report a case of a 70-year-old male who presented with a rapidly enlarging, painful plaque on the anterior thigh. The lesion had been progressing over a few weeks and was associated with tenderness. Skin biopsy revealed sheets of large epithelioid cells with vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Mitotic figures were frequent. Immunohistochemistry showed strong positivity for CD31 and ERG, supporting a diagnosis of epithelioid angiosarcoma. Markers for epithelial and melanocytic tumors were negative. Kaposi’s sarcoma and metastatic carcinoma were considered but excluded based on the absence of characteristic histological features and lack of immunoreactivity for cytokeratins and HHV-8. Given the localized nature of the lesion, wide local excision was planned. Adjuvant radiotherapy was considered due to high risk of local recurrence. The patient is currently under close oncologic follow-up. Targeted therapies were discussed as potential options depending on disease progression. CEA is a rare and often misdiagnosed entity due to its variable presentation and resemblance to other cutaneous malignancies. Early histological and immunohistochemical evaluation is key to diagnosis. Prompt, multidisciplinary intervention is essential to improve patient outcomes.