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An 85-year-old woman presented with an indurated rash that over the preceding 6 months had progressed to a well demarcated, violaceous lesion covering the majority of the right side of the cheek, temple area, and scalp. The rash was originally thought to represent angioedema from angiotensin-converting enzyme inhibitor medication prescribed for hypertension. Despite a change in this medication, the skin lesion persisted. The patient received a course of antibiotics followed by a course of oral prednisone without benefit. A skin biopsy was obtained and a diagnosis of angiosarcoma was made. The patient’s medical history was significant for well-controlled hypertension, bilateral hip replacements due to osteoarthritis, and hysterectomy for dysfunctional uterine bleeding. Her medications included losartan and vitamins. A limited staging evaluation was performed with a computed tomography scan of the head and sinuses, which revealed only indurated, dermal thickening widely dispersed over the areas noted above. There was no indication of metastatic disease. The patient was initially treated with paclitaxel 90 mg/m2 weekly. At the 6th week assessment, a partial response was noted, with resolution of the discoloration and reduced thickness of the facial lesions. The skin, however, remained indurated. Following a 2-week break, paclitaxel at 80 mg/m2 was resumed for an additional 15 weekly doses. At the final visit, her skin appeared normal. The patient then moved out of state to a warmer climate. Two months later, her skin lesions started to progress, with reddish discoloration and nodular lesions on the scalp. She received 1 dose of paclitaxel at