Local Therapies for Kaposi Sarcoma

Local therapies may be offered to people with human immunodeficiency virus (HIV) and Kaposi sarcoma if their doctor considers them to be in a “good risk” category, meaning their immune system is functioning well and Kaposi sarcoma has not spread widely. Specifically, being in a good risk category means the Kaposi sarcoma lesions are confined to the skin or lymph nodes, and lesions in the mouth are limited to the palate, or roof of the mouth. To be considered in the good risk category, a person with HIV and Kaposi sarcoma also needs to have levels of CD4—which are white blood cells that help fight infection—of more than 200 cells per microliter.

In addition to local therapies, people with HIV and Kaposi sarcoma who are in the good risk category may receive antiretroviral therapy to help boost the immune system and to help keep HIV from progressing to acquired immunodeficiency syndrome (AIDS).

Local therapies may not stop the development of new lesions. Growths can also reappear after treatment. Local therapies range from topical medications and radiation therapy to surgical approaches. Your doctor can discuss which option may be right for you.

Intralesional chemotherapy is typically an option for small Kaposi sarcoma lesions on the skin or small tumors inside the mouth. A chemotherapy drug called vinblastine is injected directly into cancerous lesions, causing them to shrink and lighten. People may experience some temporary redness or pain at the injection site.

Intralesional injections help you to avoid the nausea, vomiting, and other side effects of systemic chemotherapy, in which the medications are injected into a vein with intravenous (IV) infusion or are taken by mouth.

If a person has a limited number of lesions on the skin, NYU Langone doctors may recommend radiation therapy. It can be used on small areas of the body, including the face. The lesions usually shrink or disappear, an effect that can last for many years.

During radiation therapy, doctors use a machine called a linear accelerator to deliver energy beams to lesions. NYU Langone doctors carefully plan treatment, so it targets only the lesions and spares healthy tissue.

Treatments are usually given every day for two weeks. Your doctor determines the best schedule for you. Side effects may include redness or irritation at the treatment site, which subsides after therapy is complete.

People with a few small Kaposi sarcoma lesions on the skin may be candidates for surgery, which can be an effective option for removing visible growths.

During a standard surgical excision, a doctor removes the entire Kaposi sarcoma lesion with a border of healthy tissue. He or she closes the incision with stitches and sends the tissue to a laboratory, where a pathologist examines it under a microscope. The pathologist then determines if the entire tumor has been removed.

A surgical excision is usually performed using a local anesthetic. People who have this procedure can typically go home the same day. They may experience some discomfort for a few days.

During electrodessication and curettage, doctors numb the skin using a local anesthetic and scrape off Kaposi sarcoma cells with a tool called a curette, which is a small scoop with sharp edges. Then they apply electricity with a probe to stop any bleeding. This process is repeated several times.

Afterward, doctors place a bandage on the treated area. No stitches are needed. You can go home the same day. The treatment may leave a small, raised scar.

The simple and quick procedure is an option for people who need to avoid surgery because of poor overall health. It is also a good option for people who have a few lesions.

The destroyed tissue from electrodessication and curettage is not sent to a pathologist for examination. That means you don’t know for sure if all the cancer cells were removed. However, because the Kaposi sarcoma lesion looks different from healthy skin, doctors can usually remove the entire cancerous growth.

The procedure can destroy growths, an effect that can last for several years.

Doctors may use cryosurgery to manage small Kaposi sarcoma lesions on the face or elsewhere on the body, where they do not grow deeply into the skin. During this procedure, the doctor applies liquid nitrogen to the growth to freeze and destroy cells. This approach may cause a blister or crusting at the treatment site. It does not require stiches.

Removal of lesions with cryotherapy often requires more than one treatment. The procedure may cause some temporary discomfort and scarring. The treatment area may take several weeks to heal.

Doctors may prescribe a topical retinoid product to manage small areas of Kaposi sarcoma on the skin. A retinoid called alitretinoin, which is made from vitamin A, can help control Kaposi sarcoma cells, slowing their growth or completely destroying lesions.

This topical product is usually applied daily for several weeks. Your doctor determines how often and how long it should be used. Although retinoids do not cause scarring, side effects may include redness and skin irritation, which subside after you stop using these products.