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| Fig. 39.2 Kaposi’s sarcoma. Multiple violaceous papules and plaques. (Courtesy of James E. Fitzpatrick, MD.) |
Epidemic Kaposi’s sarcoma has a widespread, symmetrical distribution of rapidly progressive macules, patches, nodules, plaques, and tumors. Common areas of involvement include the trunk, extremities, face, and oral cavity. Early lesions consist of erythematous macules, patches, or papules that may have a bruiselike halo. They enlarge at different rates and tend to be oval or elongated in shape, following the lines of skin cleavage. The color varies from pink to red, purple, or brown and can easily mimic purpura, hemangiomas, nevi, sarcoidosis, pityriasis rosea, secondary syphilis, lichen planus, basal cell carcinoma, and melanoma.
The surface may become scaly, hyperkeratotic, ulcerated, or hemorrhagic. Disfigurement and pain secondary to edema can occur, especially on the face, genitals, and lower extremities.
Koebnerization, or formation of new lesions at sites of trauma, can be seen. Secondary bacterial infection can also occur. Lesions can be arranged in several known patterns, such as a follicular (clustered) pattern (Fig. 39-2), pityriasis rosea–like pattern, or dermatomal pattern.
