Dermatologic Manifestations of Kaposi Sarcoma Treatment & Management

Updated: Apr 19, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
  • Print
Treatment

Medical Care

Because the natural history of Kaposi sarcoma (KS) is variable, assessment of therapy may be difficult. Treatment usually is based on the extent of disease and the patient's immune status. The optimal therapy of KS-AIDS is yet to be determined. The challenge is to treat KS-AIDS effectively without immunocompromising the patient further, or better, with reconstitution of the immune system.

Management modalities for Kaposi sarcoma include nonintervention, surgical removal of skin nodules or severely affected areas (eg, areas of the extremities, intussuscepted bowel), laser surgery, conventional and megavoltage radiotherapy, chemotherapy, immunotherapy, antiviral drugs, and cessation of immunosuppressive therapy in iatrogenically immunosuppressed patients.

Indolent skin tumors in elderly white patients may not require specific therapy early in the course of the disease; however, systemic vinblastine (or other chemotherapy) attacks both cutaneous and visceral lesions.

Localized nodular disease may respond well to surgical excision, radiotherapy, and intralesional and outpatient low-dose vinblastine chemotherapy. The latter combination of local and systemic regimens may be preferable. The authors usually inform patients that this is a multicentric disease that has silent gut lesions that also may regress with the systemic approach. Although the authors prefer intralesional vinblastine, intralesional vincristine as first-line therapy for nodules in classic Kaposi sarcoma has also been recommended. [65]

The efficacy of taxanes (eg, paclitaxel, docetaxel), as agents with antiangiogenic properties, has been shown for patients with AIDS-associated Kaposi sarcoma and in those with refractory or life-threatening Kaposi sarcoma without HIV infection. [66] Pegylated liposomal doxorubicin is now being used as a second-line therapy in the treatment of patients with advanced classic Kaposi sarcoma. [67]

Limited experience for classic and HIV-related cutaneous Kaposi sarcoma treated with 0.1% topical timolol gel has shown that it can be beneficial. [68]

Radiotherapy is an option for some Kaposi sarcoma patients. Radiotherapy often produces good therapeutic results with classic nodular Kaposi sarcoma but tends to be only palliative in patients with Kaposi sarcoma and AIDS. In localized nodular Kaposi sarcoma, conventional radiotherapy is highly effective.

Electron-beam radiotherapy, which has limited penetration beyond the dermis, may be a good modality for superficial lesions.

Deeper or unresponsive Kaposi sarcoma may be treated using standard non–electron-beam radiation or other options.

Initial response to radiotherapy usually is complete or demonstrates marked regression of the nodules. The more extensive the involvement, the less responsive it tends to be.

Radiotherapy may be more effective on new, rather than chronic, lesions and may provide local Kaposi sarcoma control in patients with KS-AIDS.

Radioisotope scanning using technetium Tc 99m may detect occult Kaposi sarcoma infiltration in the subcutaneous and muscular tissues and draining lymph nodes. This allows improved efficiency of large-field radiotherapy.

Argon laser photocoagulation therapy also may be beneficial in classic Kaposi sarcoma lesions. Similarly, classic Kaposi sarcoma may favorably respond to long-pulse neodymium-doped yttrium aluminum garnet laser therapy. [69]

Next:

Surgical Care

Solitary Kaposi sarcoma lesions may be excised surgically or removed using laser surgery.

Previous
Next:

Consultations

Treating patients with advanced Kaposi sarcoma often requires a team approach, as follows:

  • Medical oncologists often administer systemic chemotherapy.

  • Radiation oncologists tend to favor radiotherapy options.

  • Infectious diseases/HIV specialists may be needed for HIV and opportunistic infections.

Previous
Next:

Prevention

Reducing the HHV-8 infection rate prevents Kaposi sarcoma development.

Suggestions have been made that some antiherpetic agents, particularly foscarnet, may lower the HHV-8 infection rate.

Screening transplant recipients for HHV-8 infection may be beneficial. [70, 71, 72, 73, 74]

Use of the highly active anti-HIV therapy HAART appears to reduce the risk of developing new Kaposi sarcoma significantly.

Previous
Next:

Long-Term Monitoring

Careful follow-up monitoring is essential for patients with Kaposi sarcoma (KS).

Previous