How would you approach unresectable cutaneous angiosarcoma of the scalp?   

Nearly the entire scalp can be reconstructed with a latissimus flap or ALT in this era. Anatomically unresectable disease is quite extensive. Clinical exam is critical upfront. While these start on the scalp, there is no barrier to spread to adjacent cutaneous areas. Look carefully at the ears ...

These patients can have good outcomes with definitive chemoRT. PET and MRI brain for staging. Shave hair and have derm examine for any satellite lesions. Induction taxane-based chemo. Then chemoRT with concurrent taxol. CTV volume is controversial but needs to be generous. At a minimum, 3-5 cm ...

We usually start with taxane based chemo and plan for local treatment based on response (surgery followed by RT a or RT alone to 66 Gy or so). If the scan is negative for nodal disease then treat primary site with margin with IMRT technique.