Angiosarcoma of the Scalp Mimicking an Inflammatory Scarring Alopecia and Diagnosed on Horizontal Histologic Sections

A 72-year-old female presented with hair loss and scalp erythema, initially diagnosed as lichen planopilaris. When topical treatments failed, a scalp biopsy using alopecia-protocol horizontal histologic sections revealed angiosarcoma, a rare primary skin cancer mimicking inflammatory alopecia. The patient received radiation and chemotherapy, achieving stable disease for several years. This case underscores the need to consider rare malignancies in suspected inflammatory alopecia cases.