Diagnosis: Kaposi’s sarcoma
Kaposi's sarcoma is a vascular neoplasm with four principal clinical variants: HIV/AIDS-related Kaposi's sarcoma, classic Kaposi's sarcoma, African endemic Kaposi's sarcoma, and immunosuppression-associated Kaposi's sarcoma. The etiologic agent in all clinical variants is human herpes virus type 8 (HHV-8). HIV/AIDS-related Kaposi's sarcoma is primarily seen in men who have sex with men.
The four variants of Kaposi's sarcoma can have different clinical presentations. In HIV/AIDS-associated Kaposi's sarcoma, patients may present with a single lesion or with symmetric widespread lesions. Clinically, the lesions can range from faint erythematous macules, to small violaceous papules, to large plaques or ulcerated nodules. The lesions are generally asymptomatic.
Any mucocutaneous surface can be involved. Common body locations include the face (especially the nose), hard palate, trunk, penis, lower legs, and soles. The most common areas of internal involvement are the gastrointestinal system and lymphatics. Histologically, atypical, angular vessels with an associated inflammatory infiltrate containing plasma cells appear in the upper dermis in macular lesions. Nodules and tumors reveal a spindle cell neoplasm pattern. Lesions stain positive for human herpes virus 8 (HHV-8).
Since the introduction of highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma has greatly decreased. HAART is the most effective treatment method, and should be the initial therapy in most patients with mild to moderate disease.
However, some patients with HIV/AIDS-associated Kaposi's sarcoma require further treatment - those who have well-controlled HIV and undetectable viral loads. Other treatments include local destruction (cryotherapy), topical alitretinoin (9-cis-retinoic acid), intralesional interferon or vinblastine, superficial radiotherapy, liposomal doxorubicin, daunorubicin, or paclitaxel.