A Lump on the Foot

Francesca Cheung, MD CCFP,1 Jeffrey Law and Lindsey Chow, 2

1Family physician with a focused practice designation in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Institute for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.
2Third year medical students from the University of Western Ontario.

CLINICAL TOOLS

Abstract: Kaposi's sarcoma (KS) is an angioproliferative tumour that requires infection by Human Herpesvirus 8 (HHV-8). It most commonly affects elderly men of Mediterranean/Eastern European backgrounds and HIV-infected patients. KS presents clinically as lesions on the skin, but may also arise in the gastrointestinal tract, lungs, and lymph nodes. There is no definitive cure for KS; therapeutic goals are to decrease the size of the lesions, prevent progression and improve function. Management depends on the type of KS, extent of disease and overall health of the patient. Observation is acceptable if the patient is asymptomatic; HAART is often sufficient to control lesions in HIV-infected patients. Cryotherapy and local excision can be used to treat solitary symptomatic lesions. Radiation therapy can be used for advanced and extended KS and in those patients for whom surgery is contraindicated. Intra-lesional injection of interferon alpha-2a or chemotherapeutic agents like vincristine have been reported to be effective in treating nodular KS lesions, but may be associated with inflammation and discomfort. Systemic chemotherapy such as pegylated liposomal doxorubicin is indicated when KS is widespread or rapidly progressive. The prognosis for KS is generally great with most patients dying from unrelated causes.
Key Words: Kaposi's Sarcoma, HHV-8, HIV/ AIDS.

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Kaposi’s sarcoma is a common tumour affecting HIV-infected patients. Classic Kaposi’s sarcoma most commonly affects elderly men of Mediteranean/Eastern European background.
Environmental and genetic factors are believed to predispose patients to Kaposi’s sarcoma. KS requires the infection of HHV-8. Chronic immune-suppression contributes to KS development.
KS presents with red/purple macules, plaques and nodules on the skin. Lesions may also arise in the oral cavity, gastrointestinal tract and lungs. Lesions affecting lymph nodes cause lymphedema. Consider KS in an HIV-infected patient who presents with erythematous and/or violaceous nodules or plaques.
Management of KS depends on the type of KS, extent and location of lesions and overall health of the individual. Observation is sufficient for asymptomatic patients. For patients with EKS, HAART is recommended and may be the only therapy needed.
Local control of KS lesions can be achieved through cryotherapy, local excision, intra-lesional injection of chemotherapeutic agents or radiation therapy.
Distant spread of KS can be controlled through systemic chemotherapy.
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