Kaposi ’ s

Sarcoma
 i o n
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In
  Kaposi ’ s sarcoma , a malignant,
multifocal neoplasm of
reticuloendothelial cells that as soft
brownish or purple papules on the feet
and slowly spreads in the skin,
metastasizing to the lymph nodes and
viscera. It occurs most often in men and
is associated with diabetes, malignant
lymphoma, acquired immunodeficiency
syndrome, or other disorders.
Three Categories
 Classic Kaposi ’ s sarcoma
> occurs predominantly in men between the ages
of 40 and 70 years who are of Eastern European
ancestry.
Endemic Kaposi ’ s sarcoma
> found most often in young men and also in
children in equatorial Africa, may infiltrate and
progress to lymphadenopathic forms.


 Immunosuppressive therapy


 > associated KS occurs when patients are

treated with immunosuppressive agents. The greater
the immunosuppressant: the higher in incidence of
KS.

 History
 

The disease is
named after
Moritz Kaposi
(1837–1902), a
Hungarian
dermatologist who
first described the
symptoms in 1872.
Research over the
next century
suggested that KS,
like some other
forms of cancer,
might be caused
by a virus or
genetic factors,
but no definite
cause was found.
Background
Knowledge
 
Etiologic Agent

Human herpesvirus 8 (HHV-8) is

also known as Kaposi sarcoma-
associated herpesvirus, or KSHV.
HHV-8: Human herpesvirus 8, a
herpesvirus that contributes to the
development of Kaposi sarcoma, an
otherwise rare form of cancer
sometimes seen in AIDS patients, and
to some B-cell lymphomas.
 > usually found in men
> highest risk of Kaposi's occurs
a m o n g m a le h o m o sexu a ls a n d b isexu a ls
in fe cte d w ith H IV
> Mediterranean , Middle Eastern
d e sce n t, a s w e lla s A frica n s ( livin g in
A frica ) h a ve a h ig h e r ra te o f th e
cla ssica lfo rm o f K a p o si's sa rco m a
> Individuals that have impairment
o f th e im m u n e syste m
> most often in people with AIDS
> whose immune system is
su p p re sse d b e ca u se th e y h a ve re ce ive d
a n o rg a n tra n sp la n t
purple spots
> Dark spots - spots appear in dark-
skinned people
> Red-purple spots on arms
> Red-purple spots on legs
> Red-purple spots in mouth
>Ulcerating spots
> Lymph gland tumors
> Bleeding from gastrointestinal lesions

> Shortness of breath from lesions in the

lung
> Bloody sputum from lesions in the lung
Diagnostic Test
> History and physical examination :
Your doctor will take your history to learn
about any past illnesses, operations, your
sexual history and other possible exposures to
KSHV and HIV. The doctor will ask you about
symptoms and about any skin tumors you have
noticed.
> Skin lesion biopsy: Skin lesions
caused by KS can resemble other kinds of skin
disorders, inflammation, bacterial or fungal
infections, non-Hodgkin's lymphoma, or a benign
tumor of the blood vessels (hemangioma).
> E n d o sco p y : In e n d o sco p y , th e d o cto r
u se s a th in , flexib le , lig h te d tu b e , ca lle d
a n e n d o sco p e , to lo o k fo r G I le sio n s. It is
a lso p o ssib le to b io p sy th e se le sio n s,
u sin g sm a llsu rg ica lin stru m e n ts
o p e ra te d th ro u g h th e e n d o sco p e .

> Im a g in g stu d ie s : T h e m o st
im p o rta n t im a g in g stu d y in K S is th e
ch e st x -ra y. T h is ca n te llif K S is in th e
lu n g . O th e r stu d ie s like C T sca n , M R I,
n u cle a r sca n s, a n d u ltra so u n d a re o n ly
o cca sio n a lly u se fu l.
Complications
Anaphylaxis: A
skin rash and
fever may be
symptoms of a
severe and
potentially life-
threatening
reaction called
anaphylaxis.
Febrile seizure: A
febrile seizure
occurs when an
infant or young
child develops a
seizure or
convulsions when
he/she has a fever
higher than 102
degrees
Fahrenheit.
Infection:
Some
infections
that cause
fever and
rash may
spread to
multiple parts
of the body
and cause
Kaposi's


sarcoma: Kaposi's
sarcoma (KS) is a
cancer that usually
causes tumors to
form in the tissues
below the skin or
face or in the
mucous
membranes of the
nose, mouth, or
anus.
rash and fever may be symptoms of a
severe allergic reaction to medications,
called Stevens-Johnson syndrome (SJS).
This condition is potentially life
threatening because, in severe cases,
the lesions can cause significant
scarring of the involved organs, which
often leads to loss of function of the
organ systems.
Prevention
K a p o sisa rco m a is ca u se d b y K a p o si
sa rco m a h e rp e sviru s ( K S H V ). T h e re a re
n o va ccin e s cu rre n tly a va ila b le to
p ro te ct p e o p le a g a in st K S H V . Fo r n o w ,
p re ve n tin g K S d e p e n d s o n re d u cin g th e
ch a n ce o f b e co m in g in fe cte d w ith K S H V
a n d re d u cin g th e ch a n ce th a t p e o p le
w h o a re in fe cte d w ith K S H V w illd e ve lo p
KS.
 > Testing for HIV can identify infected
people. People with HIV should get treatment to
help strengthen their immune system, which
usually includes highly active antiretroviral
therapy (HAART). HAART reduces the risk of
developing KS in people with HIV.
> KSHV is not tested for routinely, but
tests are available that could be used to
identify HIV-infected patients who are at risk
for KS. Studies have shown that HIV-infected
people who take several different drugs that
block herpesvirus (ganciclovir or foscarnet)
are less likely to develop KS because these
drugs also work for KSHV.
Medical management
the cell surface. once bound to the cell
membrane, interferon initiates a complex
sequence of intracellular events that include
the induction of certain enzymes. It is
thought that this process, at least in part, is
responsible for the various cellular responses
to interferon, including inhibition of virus
replication in virus-infected cells, suppression
of cell proliferation and such
immunomodulation activities as
enhancement of the phagocytic activity of
macrophages and augmentation of the
specific
 
cytotoxicity of lymphocytes for target cells.
All of these activities possibly contribute to
interferon's therapeutic effect
Liquid Nitrogen Cryotherapy Causes
a local blister; a scab then forms and
eventually sloughs. In fair-skinned
individuals, healing often occurs
without significant scarring or
discoloration.
Intralesional Vinblastine
Intralesional injection of
the anti- neoplastic agent
vinblastine tends to induce a
more severe local inflammatory
process than does liquid
nitrogen, and is associated with
significant pain.
Intralesional Human
Chorionic Gonadotropin
Gill and colleagues have
demonstrated that
intralesional injection of
human chorionic gonadotropin
(hCG) induces local KS
regression.
 There was general consensus that
systemic chemotherapy has no role in
the management of KS that is
characterized by only a few
asymptomatic cutaneous lesions,
whether on the face or in other
locations.
Surgery Management :
  Surgery is used for treating
local areas of KS. Surgery refers to
an operation to remove or destroy
the cancer. Types of surgery include:
· Surgical excision to remove KS
lesions
· Electrodesiccation and curettage
which uses an electric probe to
destroy the tissue with heat; the
tissue is then scraped away.
· Cryosurgery which uses a super
cold probe to freeze the tissue
Radiation Therapy
  Radiation therapy uses high-energy
radiation to kill cancer cells. External beam
radiation therapy uses radiation delivered
from outside the body that is focused on the
cancer.
  Chemotherapy uses anticancer drugs
that usually are given into a vein or by
mouth. These drugs enter the bloodstream
and reach all areas of the body, making this
treatment useful for cancer that has spread
or metastasized to areas of the body away
from the skin. In KS, the drugs can also be
injected directly into a tumor.
ANATOMY AND

PHYSIOLOGY
OF SKIN
 T h e skin is a n e ve r-ch a n g in g o rg a n
th a t co n ta in s m a n y sp e cia lize d ce lls a n d
stru ctu re s. T h e skin fu n ctio n s a s a
p ro te ctive b a rrie r th a t in te rfa ce s w ith a
so m e tim e s-h o stile e n viro n m e n t. It is
a lso ve ry in vo lve d in m a in ta in in g th e
p ro p e r te m p e ra tu re fo r th e b o d y to
fu n ctio n w e ll. It g a th e rs se n so ry
in fo rm a tio n fro m th e e n viro n m e n t, a n d
p la ys a n a ctive ro le in th e im m u n e
syste m p ro te ctin g u s fro m d ise a se .
Epidermis
The epidermis is the outer layer of skin. The thickness of
the epidermis varies in different types of skin. It is the
thinnest on the eyelids at .05 mm and the thickest on the palms
and soles at 1.5 mm.

Dermis
The dermis also varies in thickness depending on the
location of the skin. It is .3 mm on the eyelid and 3.0 mm on the
back. The dermis is composed of three types of tissue that are
present throughout - not in layers.

Subcutaneous Tissue
The subcutaneous tissue is a layer of fat and connective
tissue that houses larger blood vessels and nerves. This layer is
important is the regulation of temperature of the skin itself
and the body. The size of this layer varies throughout the body
and from person to person.
NCP ( Nursing Care Plan)