Overview
Kaposi sarcoma (KS) is a multifocal angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8) and often linked to immunosuppression, particularly in HIV-positive individuals 41.Diagnosis
Clinical Presentation: Persistent skin nodules, particularly on lower extremities, mucocutaneous lesions, and involvement of lymph nodes, lungs, and gastrointestinal tract 15.
Biopsy: Histopathologic examination is essential for diagnosis, often requiring CD34 positivity for differentiation from other spindle cell neoplasms 1.
Imaging: Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) useful for detecting multifocal lesions and monitoring treatment response 5.Management
First-Line Treatments:
- Chemotherapy: Antiretroviral therapy (ART) in HIV-positive patients is foundational 3.
- Targeted Therapy: Pembrolizumab shows antitumor activity in both classic and endemic KS 2.
Adjunctive Treatments:
- Surgical: Excision with wider margins for localized lesions, such as those on the glans penis 8.
- Radiation Therapy: May be used for localized disease or symptom management 3.Special Populations
HIV-Positive Patients: ART is crucial for managing KS in this population 3.
Elderly: Diagnostic delays can occur due to atypical presentations; dermatology specialist involvement improves care 3.Key Recommendations
Employ histopathologic examination with CD34 staining for definitive diagnosis of Kaposi sarcoma (Evidence: Strong 1).
Integrate antiretroviral therapy in the management of HIV-associated Kaposi sarcoma to improve outcomes (Evidence: Strong 3).
Utilize whole-body FDG-PET/CT for comprehensive lesion detection and monitoring treatment response in Kaposi sarcoma (Evidence: Moderate 5).
Consider targeted therapies like pembrolizumab for patients with Kaposi sarcoma, especially when conventional treatments are insufficient (Evidence: Moderate 2).
Enhance diagnostic accuracy and reduce delays by involving dermatology specialists in high-prevalence areas (Evidence: Moderate 3).References
1 Cusick AS, Wan L, Casey AS, Baiocchi R, Fabbro SK. Diagnostic pitfalls: how availability and anchoring biases lead to errors in dermatology. Diagnosis (Berlin, Germany) 2026. link
2 . Pembrolizumab Is Safe and Effective in Kaposi Sarcoma. Cancer discovery 2022. link
3 Williams VL, Narasimhamurthy M, Rodriguez O, Mosojane K, Bale T, Kesalopa K et al.. Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana. Journal of global oncology 2019. link
4 Karamanou M, Antoniou C, Stratigos AJ, Saridaki Z, Androutsos G. The eminent dermatologist Moriz Kaposi (1837-1902) and the first description of idiopathic multiple pigmented sarcoma of the skin. Journal of B.U.ON. : official journal of the Balkan Union of Oncology 2013. link
5 Morooka M, Ito K, Kubota K, Minamimoto R, Shida Y, Hasuo K et al.. Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography images before and after chemotherapy for Kaposi sarcoma and highly active antiretrovirus therapy. Japanese journal of radiology 2010. link
6 Szep Z. The life of Mor Kaposi in Bratislava (1853-1856). Bratislavske lekarske listy 2003. link
7 Leoncini L, del Vecchio MT, Minacci C, Pieragalli D, Monaci A. Kaposi's sarcoma of lymph nodes associated with multicentric angiofollicular hyperplasia. Applied pathology 1989. link
8 Conger K, Sporer A. Kaposi sarcoma limited to glans penis. Urology 1985. link90055-x)