Kaposi’s sarcoma (syn. Kaposi’s haemorrhagic sarcoma)

Kaposi's sarcoma is a malignant, cutaneous, vascular proliferation arising in several different clinical contexts.

This chapter is set out as follows:

There are four subgroups of Kaposi's sarcoma:

• The most frequent occurrence is in patients with HIV, which is associated with a poor prognosis

• Non-HIV immunosuppression eg transplant patients. It can regress if immunosuppression ceases, but it can be aggressive and associated with a poor prognosis

• Sporadic - mainly found in middle-aged and elderly males of Mediterranean or Ashkenazi Jewish descent. Ashkenazi Jews are descended from Jewish communities that lived in central and eastern Europe. Most Jewish people in the UK are of Ashkenazi Jews ancestry. Lesions begin insidiously around the ankle and slowly spread upwards. Lesions are rarely fatal

• Endemic - Zaire, Uganda and Rwanda. There is a relatively benign nodular group, and a fulminant lymphadenopathic variety seen in children

Distribution

• Depends on the cause
• The face and extremities are the most common sites, although any site can be affected including the mouth and other mucosal areas 

Morphology

• Dark blue / purple colour 
• Lesions start off flat, then become raised and tumid growing up to 3 cm in diameter 
• Tend to be multifocal and adjacent areas may fuse to form large plaques
• Can become ulcerated 
• Some involute to leave pigmented scars

• Routine bloods and an HIV test 

• Suspected cases should be referred urgently to Secondary Care (two-week wait) 
• A multi-disciplinary team approach may be required