Bilateral pneumothorax as a presenting feature of metastatic angiosarcoma of the scalp

Angiosarcoma of the scalp is a rare highly malignant tumour which frequently metastasizes to lung (Holden et al, 1987). Here we report a case of bilateral pneumothorax in a man with apparently localized angiosarcoma of the scalp This case illustrates the need to be aware of the aggressive nature of this tumour and to suspect metastases when pulmonary complications develop. In June 1988, a 77-year-old man presented with a 6 week history of an enlarging lesion on his scalp. On examination, there was a 3 cm diameter pink-purple nodule with several smaller satellite lesions extending for a further 1 cm. There were no palpable lymph nodes. A biopsy of this lesion showed it to be an angiosarcoma. The scalp lesion was completely excised and the area grafted. The histology of the excised lesion confirmed an angiosarcoma which was completely excised but close to the deep excision line.