Local Therapy for Kaposi Sarcoma

Local treatment only affects certain Kaposi sarcoma (KS) lesions (or areas of lesions). This type of treatment is often used to treat a few skin lesions in one spot to help a person look or feel better. Local therapy is most useful when there are just a few lesions in a very visible area (such as the face). The drawbacks of local therapy are that it doesn’t treat lesions anywhere else and it can’t keep new lesions from developing.

Sometimes, the doctor might recommend just observation if a person's immune system is functioning well from treatment with highly active antiretroviral therapy (HAART) or transplant medications, and the areas of KS are small and not bothersome to the person.

Topical treatment

This type of treatment puts medicine directly on the lesion. For example, alitretinoin, a retinoid drug related to vitamin A, is available as a gel that can be used to treat KS skin lesions. When it is placed on a KS lesion 2 to 4 times a day, it makes it get smaller or go away in 1 to 3 months. Side effects of this gel include skin irritation and lightening of the skin.

Imiquimod is a cream that can also be used to treat KS skin lesions. It is applied three times a week for 24 weeks and may cause some itching and redness where it is used.

Cryosurgery (cryotherapy)

Cryosurgery can be useful for small KS lesions on the face, although it is not as helpful for large or deep lesions. Liquid nitrogen is applied to the tumor to freeze and kill the cells. After the dead area of skin thaws, it may swell, blister and crust over. The wound may take several weeks to heal, and the skin of the treated area may be lighter after treatment.

Surgery

When a person has only a few, small Kaposi sarcoma lesions, one option may be to remove them with surgery. This can be done in different ways.

Simple excision: The skin is first numbed with a local anesthetic. The tumor is then cut out with a surgical knife, along with some surrounding normal skin. The remaining skin is carefully stitched back together, leaving a small scar.

Curettage and electrodesiccation: The tumor is removed by scraping it with a curette (a long, thin instrument with a sharp looped edge on one end), then treating the area with an electric needle (electrode) to try to destroy any remaining cancer cells. This process can be repeated.

A drawback of surgery is that the lesion might recur (come back) in the same place.

Surgery may also be an option for a single KS lesion that is blocking the air entering the lungs or blocking the urinary system.

Intralesional chemotherapy

A small amount of a chemotherapy drug is injected directly into the KS lesions. Very little of the drug is absorbed into the body. This lets the patient avoid many of the side effects normally seen with chemotherapy.

The most common drug used for intralesional chemotherapy in KS is vinblastine. Some people may have swelling, blistering, and pain at the injection site with this type of treatment.

Photodynamic therapy (PDT)

A special liquid drug is applied to the skin. The drug collects in the tumor cells over several hours or days and makes the cells sensitive to certain types of light. A special light source is then focused on the tumor(s), and the cells die. A possible side effect of PDT is that it can make the skin very sensitive to sunlight for some time, so precautions may be needed to avoid severe burns.

For more information on this technique, see Photodynamic Therapy.

Radiation therapy

Radiation can also be used as a local treatment for KS.