Classic Kaposi Sarcoma

For 1 month, a 66-year-old man had had an asymptomatic lesion on the dorsum of his left hand. The flesh-colored, dome-shaped, maroon-crusted lesion measured 0.7 cm and was located over the fourth knuckle. The patient had chronic obstructive pulmonary disease but was otherwise in good health. He was seronegative for HIV.

The lesion was excised; pathological examination revealed atypical vascular proliferation in the dermis featuring spindle-shaped cells with vascular slits and extravasation of erythrocytes. Mitotic activity was present, and cytoplasmic inclusion bodies were also noted.

Classic Kaposi sarcoma was diagnosed in light of the patient’s age and the absence of AIDS. The classic form is rare; most often, men of Jewish, Greek, or Italian descent who are in the fifth to seventh decades of life are affected. Typically, eruptions occur on the extremities, especially the legs and feet. Edema may precede or follow the appearance of lesions. Spontaneous regression can occur; generally the disease progression is chronic and slow. The lymph nodes and viscera may become involved; however, death usually results from an unrelated cause.

The lesions of classic Kaposi sarcoma are generally asymptomatic, although pain or pruritus may occur. In addition to excision, liquid nitrogen, radiation, and intralesional vinblastine may be used to remove lesions.