Background: Scalp angiosarcoma is an aggressive tumor characterized by a rapid and fatal course. The overall prognosis of scalp angiosarcomas is poor. Recently, paclitaxel was found to be useful for scalp and facial angiosarcomas. Methods: We conducted a retrospective review of paclitaxel in the treatment of scalp angiosarcoma patients who were admitted to the Veterans General Hospital, Taipei from 1996 to 2005 (10 years). Of these patients, 4 initially received paclitaxel and radiotherapy (1 patient underwent surgery in addition to this treatment), and 6 patients underwent either surgery alone or surgery combined with radiotherapy. Disease-free interval and overall survival duration were calculated. Statistic analyses were carried out using Student's t-test. Results: The disease-free interval was significantly prolonged in patients who received paclitaxel in the initial treatment protocol (17.8 vs. 5.7 months, p = 0.016). The overall survival duration was also prolonged in these patients; however, the difference was not significant (26.5 vs. 11.1 months, p = 0.075). The prognosis was poor in the case of disease recurrence or metastases. Conclusions: Although it was difficult to completely eliminate selection bias in this retrospective review due to the limited number of cases, paclitaxel as an initial treatment regimen for primary scalp angiosarcoma after surgery or radiotherapy appeared to prolong the disease-free interval and improve patients' quality of life.