27th June 2023

Kaposi’s sarcoma

Kaposi’s sarcoma is an angioproliferative neoplasm classically seen on the lower limbs of mostly elderly men, predominantly of Mediterranean extraction, however, is many orders of magnitude more frequent in patients with immunosuppression due to HIV or iatrogenic immunosuppression. It is caused by the Kaposi’s sarcoma herpes virus, which establishes lifelong latency. Kaposi’s sarcoma is much more common in men who have sex with men, even in the absence of HIV, and it is also more common in Sub-Saharan Africa. It is less frequent among patients on antiretroviral treatment.

Key features on presentation:

• Skin lesions – multiple pigmented lesions, often following Langer lines, raised or flat, with pink to purple colouration
• Oral lesions are more common in HIV, often nodular lesions within the oral mucosa
• Lymphadenopathy is more common in children and teenagers
• The tumour may spread to the lungs and gastrointestinal tract if HIV-related Kaposi’s sarcoma is left untreated

Diagnosis is often clinical, but biopsy for histological confirmation with diagnosis is recommended.
Management of Kaposi’s sarcoma in the context of HIV is with antiretroviral therapy. Other treatment depends on the stage of the cancer:

• T0 cancer can be managed with antiretroviral therapy
• In more advanced cancer, liposomal anthracycline therapy with doxorubicin or daunorubicin should be given alongside antiretroviral therapy
• Surgery can be used for symptoms or to control local growth

Prognosis is poorer in older patients and the presence of the human herpes virus.