Pathology

1. Kaposi sarcoma
   • Derived from capillary endothelial cells or from fibrous tissue
   • Linked to human herpes virus 8 (HHV8) aka Kaposi sarcoma herpes virus KSHV
2. Classical Kaposi sarcoma
   • First described in Askenazi Jews
   • Found on legs of elderly men
   • Confined to skin
   • Not fatal
3. AIDS-associated Kaposi's sarcoma
   • Found in 1/3 patients with AIDS (diagnostic of AIDS)
   • More common in homosexual patients
   • 1/3 develop a second malignancy (eg leukaemia, lymphoma)
4. Endemic (central African)
   • Aggressive invasive tumour
   • Ultimately fatal
   • Good response to chemotherapy
5. Transplantation associated Kaposi sarcoma
   • Following high-dose immunosuppressive therapy
   • Often regress when treatment stopped

Approach

• Examine as for any lump

1. Inspect
   • Purple papules or plaques
   • Solitary or multiple
   • Can be found anywhere on skin or on mucose of any organ but usually found on the limbs, mouth, tip or nose or palate

Completion

1. Take history
   • Ethnic origin (Jew, black)
   • Previous transplant
   • Underlying immunosuppression (without saying HIV or AIDS directly)  

Treatment

1. Leave alone if asymptomatic and if patient does not want intervention
2. Intervene only when extensive or for cosmetic reasons
   • Local radiotherapy
   • Chemotherapy - INFa, doxorubicin, intralesional vinblastine
   • (if in context of HIV infection - adequate anti-retroviral therapy)