Atypical vascular lesions (AVLs) of the breast are purple papules or nodules that have been reported in breast cancer patients following radiation treatment, typically presenting with fewer than 5 lesions at diagnosis. We report a patient with 29 lesions within previously irradiated breast tissue. Due to the large number of lesions and concern for development of angiosarcoma, the patient's case was brought before a multidisciplinary tumor board that decided she should undergo a radical mastectomy with flap reconstruction. We discuss the dermatologist's role in managing this complex and increasingly common disorder.
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