Skin Cancer in Skin of Color

Porcia T. Bradford


Dermatology Nursing. 2009;21(4):170-77; 206. 

In This Article

Kaposi Sarcoma

Kaposi sarcoma (KS) is one of the most common cutaneous soft tissue sarcomas (see Table 5). There are four types: classic KS, which typically occurs in middle-aged and elderly men of Mediterranean and Ashkenazi Jew background; endemic KS, which is seen among native residents of equatorial Africa, where it composes about 10% of reported cancers; immunocompromised KS, which occurs following solid-organ transplantation or in patients receiving immunosuppressive therapy; and epidemic AIDS-related KS, which is the most clinically aggressive form of KS (Schwartz, Micali, Nasca, & Scuderi, 2008). The human herpes-virus type 8 (HHV-8) virus is a known cause of KS (Dourmishev, Dourmishev, Schwartz, & Lukac, 2003).

Because KS is one of the common manifestations of AIDS, its incidence and demographic patterns mimic trends seen for AIDS. Approximately 15% of all patients with AIDS develop KS (Schwartz et al., 2008). In a recent review of cutaneous soft tissue tumors, it was shown that Blacks had a higher incidence of KS than Caucasians, 23.5 and 17.5 per 1,000,000 person-years, respectively (Rouhani, Fletcher, Devesa, & Toro, 2008). Asians had a much lower incidence rate of KS (4.0 per 1,000,000 person-years).

Cutaneous KS is characterized by painless, violaceous macules, nodules, or plaques (see Table 5). In contrast to Caucasians, the violaceous hue may be difficult to detect in dark-skinned individuals (Halder & Bridgeman-Shah, 1995). KS can be an indolent disease with only skin manifestations commonly found on the lower extremities, or rapidly lead to progressive cutaneous and visceral disease (Schwartz et al., 2008). AIDS-associated KS first manifests as multiple nodules on the upper body and head and neck, swiftly evolving on the skin and in the viscera (Jessop, 2006). Chronic lymphedema may also be found in KS (Schwartz et al., 2008).

Clinical classification of KS may be the best prognostic indicator. Among patients with classic KS, prognosis appears to correlate with the degree of immunosuppression and older age. Locally aggressive KS has an intermediate prognosis, with the old African estimate of a 3-year survival rate of 64% still accurate. Generalized KS, the form seen most commonly in patients with AIDSassociated KS, has a 3-year survival rate closer to zero without therapy (Schwartz et al., 2008).

All types of KS are radiosensitive. HAART (highly active antiretroviral therapy) has reduced the incidence of KS in HIV-infected patients by 10-fold. Effective HAART after 6 months is associated with involution of KS lesions in approximately 50% of patients. Intralesional chemotherapy, cryosurgery, and radiation have also been used (Schwartz et al., 2008).


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