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Patient Case: Skin Tumors – Kaposi’s Sarcoma and Squamous Cell Carcinoma

Patient Case: Skin Tumors – Kaposi’s Sarcoma and Squamous Cell Carcinoma

Discussion

A 52-year-old male presents to the dermatology clinic with multiple dark reddish-purple nodules on his lower legs, some of which have coalesced into larger plaques. He reports that the lesions began as small flat patches a year ago and have gradually increased in number and size. He also experiences occasional swelling in his legs. Additionally, he has a history of unexplained weight loss and intermittent fever over the past several months. A biopsy of the lesions confirms the diagnosis of Kaposi’s sarcoma. Further testing reveals an underlying immunocompromised state.

In the same clinic, a 68-year-old male farmworker with a history of chronic sun exposure presents with a non-healing ulcerated lesion on his left temple. The lesion has been slowly enlarging over the past eight months and occasionally bleeds. Examination reveals a scaly, crusted plaque with an indurated base. A biopsy confirms squamous cell carcinoma. Given the lesion’s location and depth of invasion, a multidisciplinary team discusses surgical excision and possible adjuvant therapy.

Both patients are counseled on their conditions, treatment options, and the importance of follow-up care.

Questions
  1. Which underlying condition is most commonly associated with Kaposi’s sarcoma?
    a) Chronic sun exposure
    b) Human papillomavirus (HPV) infection
    c) Human immunodeficiency virus (HIV) infection
    d) Fungal skin infections
  2. What is the primary risk factor for squamous cell carcinoma in the second patient?
    a) Genetic predisposition
    b) Chronic sun exposure
    c) Fungal skin infections
    d) Exposure to polluted water
  3. Which histological finding is characteristic of Kaposi’s sarcoma?
    a) Atypical keratinocytes invading the dermis
    b) Spindle-shaped cells with slit-like vascular spaces
    c) Hyperpigmentation of the basal layer
    d) Langerhans cell proliferation
  4. What is the most appropriate treatment approach for the squamous cell carcinoma patient with an invasive lesion?
    a) Topical corticosteroids
    b) Oral antifungal therapy
    c) Surgical excision
    d) Radiotherapy alone
Reveal answers

Answers

  1. (c) Human immunodeficiency virus (HIV) infection
    • Kaposi’s sarcoma is strongly associated with HIV/AIDS and human herpesvirus-8 (HHV-8) infection. It is considered an AIDS-defining illness.
  2. (b) Chronic sun exposure
    • Long-term UV radiation exposure is a major risk factor for squamous cell carcinoma, especially in outdoor workers and elderly individuals.
  3. (b) Spindle-shaped cells with slit-like vascular spaces
    • Kaposi’s sarcoma is characterized histologically by spindle-shaped cells, vascular proliferation, and red blood cell extravasation.
  4. (c) Surgical excision
    • The primary treatment for localized squamous cell carcinoma is surgical excision to ensure complete removal and reduce recurrence risk. Depending on the depth and spread, other treatments like radiotherapy may be considered adjunctively.