Classic Kaposi's 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 in diameter 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; pathologic 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. The histologic picture was characteristic of Kaposi's sarcoma.

In light of the patient's age and the absence of AIDS, Robert P. Blereau, MD of Morgan City, La, diagnosed the classic form of this disease. Kaposi's sarcoma commonly occurs in Africa and is seen in patients with AIDS or in those otherwise immunosuppressed.

Classic Kaposi's sarcoma 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, 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's 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.

FOR MORE INFORMATION:

• Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St Louis: Mosby–Year Book; 1996:733-734.

• Weedon D. Skin Pathology. Edinburgh: Churchill Livingstone; 1997:839-843.