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For further information, see CMDT Part 6-42: Kaposi Sarcoma
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Essentials of Diagnosis
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General Considerations
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Classic Kaposi sarcoma
Endemic Kaposi sarcoma occurs in an often aggressive form in young black men of equatorial Africa
Iatrogenic Kaposi sarcoma
HIV-related Kaposi sarcoma
Prevalence has been reduced due to antiretroviral therapy
However, continues to occur in both well controlled HIV infection or AIDS
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Red, purple, or dark plaques or nodules on cutaneous or mucosal surfaces
Marked edema may occur with few or no skin lesions
Commonly involves the gastrointestinal tract, but in asymptomatic patients these lesions are not sought or treated
Pulmonary Kaposi sarcoma
Can present with shortness of breath, cough, hemoptysis, or chest pain
May be asymptomatic, appearing only on chest radiograph
Chronic Kaposi sarcoma
Can develop in patients with HIV infection, high CD4 counts, and low viral loads
Usually resembles the endemic form, being indolent and localized
However, it can be clinically aggressive
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Differential Diagnosis
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Kaposi sarcoma in the elderly
In the setting of iatrogenic immunosuppression
AIDS-associated Kaposi
Other therapeutic options include cryotherapy or intralesional vinblastine (0.1–0.5 mg/mL) for cosmetically objectionable lesions
Systemic chemotherapy
Indicated for rapidly progressive skin disease (more than 10 new lesions per month), with edema or pain, and with symptomatic visceral disease or pulmonary disease
Liposomal doxorubicin
Other therapeutic options include
Paclitaxel
Etoposide
Bortezemib
Lenalidomide
Targeted immunotherapy with PD-1/PDL-1 blockade (nivolumab, pembrolizumab) has been successful in small series
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Therapeutic Procedures
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