Composite hemangioendothelioma presenting as a scalp nodule with alopecia.

To the Editor: Composite hemangioendothelioma (CHE) is a low-grade vascular tumor with a tendency for local recurrence but low metastatic potential. 1 Nayler S.J. Rubin B.P. Calonje E. Chan J.K. Fletcher C.D. Composite hemangioendothelioma: a complex, low-grade vascular lesion mimicking angiosarcoma. Am J Surg Pathol. 2000; 24: 352-361 Crossref PubMed Scopus (112) Google Scholar Histopathologically, CHE shows varying combinations of benign, low-grade, and malignant vascular components. 1 Nayler S.J. Rubin B.P. Calonje E. Chan J.K. Fletcher C.D. Composite hemangioendothelioma: a complex, low-grade vascular lesion mimicking angiosarcoma. Am J Surg Pathol. 2000; 24: 352-361 Crossref PubMed Scopus (112) Google Scholar Less than 30 cases have been reported. 1 Nayler S.J. Rubin B.P. Calonje E. Chan J.K. Fletcher C.D. Composite hemangioendothelioma: a complex, low-grade vascular lesion mimicking angiosarcoma. Am J Surg Pathol. 2000; 24: 352-361 Crossref PubMed Scopus (112) Google Scholar , 2 Tsai J.W. Huang H.Y. Lee J.C. Yen Y.S. Tung C.L. Huang C.C. et al. Composite hemangioendothelioma: report of four cases with emphasis on atypical clinical presentation. Pathology. 2011; 43: 176-180 Crossref PubMed Scopus (19) Google Scholar , 3 Fukunaga M. Suzuki K. Saegusa N. Folpe A.L. Composite hemangioendothelioma: report of 5 cases including one with associated Maffucci syndrome. Am J Surg Pathol. 2007; 31: 1567-1572 Crossref PubMed Scopus (67) Google Scholar It typically manifests as an infiltrative mass or ill-defined swelling on a distal limb. 1 Nayler S.J. Rubin B.P. Calonje E. Chan J.K. Fletcher C.D. Composite hemangioendothelioma: a complex, low-grade vascular lesion mimicking angiosarcoma. Am J Surg Pathol. 2000; 24: 352-361 Crossref PubMed Scopus (112) Google Scholar We report an unusual case of CHE on the scalp.