Which malignancies cause cutaneous manifestations of HIV infection?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Kaposi sarcoma (KS) was the first reported malignancy associated with HIV infection and was first documented in 1981 from reports in New York, Los Angeles, and San Francisco. [20] The worldwide prevalence of KS in patients with AIDS may approach 34%; in the United States; however, the prevalence of KS in patients with HIV disease is less than 5%. Most of the patients are homosexual men, although all patients who acquire HIV infection through sexual contact are at somewhat increased risk. Lymphedema from KS so severe as to be evident as elephantiasis nostras verrucose may occur. [21] One should also be aware of mimickers of KS, including acroangiodermatitis. [22]

Since the advent of highly active antiretroviral therapy (HAART), the incidence of non–AIDS-defining cutaneous cancers—in particular, basal cell carcinoma—among HIV-infected persons has exceeded that of AIDS-defining cutaneous cancers such as KS. In a prospective study, Crum-Cianflone et al found that 6% of HIV-infected persons developed a cutaneous malignancy over a mean follow-up period of 7.5 years. [23]

The development of cutaneous non–AIDS-defining cancers in this cohort proved to be associated with the traditional risk factors of increasing age and lighter skin color, rather than with CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART. [23]

KS remains the most common HIV-associated malignancy in sub-Saharan Africa. [24] Pediatric KS is distinct, and lymph node involvement is a common manifestation.

AIDS-related B-cell non-Hodgkin lymphomas may cause skin nodules.

HIV-infected patients may also develop cutaneous T-cell lymphoma. [25] Amazingly, they had higher survival and lower mortality than those non–HIV-infected persons, possibly because of antiretroviral therapy restoring immune functions.

Anal carcinoma and cervical intraepithelial neoplasia are papillomavirus-associated tumors associated with HIV disease. These tumors tend to be more progressive and aggressive. An increase in squamous cell carcinoma of the anal mucosa has been reported, especially in young homosexual men with HIV infection.

Intraoral or multiple squamous cell carcinoma, Bowen disease, and metastatic basal cell carcinoma have occasionally been reported in patients infected with HIV.

Malignant melanoma appears to be more aggressive in patients with HIV. One study reported shorter disease-free and overall survival rates in patients with melanoma who had HIV disease, compared with those who did not have HIV. [26]

Children with AIDS have a higher risk of developing leiomyosarcoma, although the incidence is still low in this population.

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