Correspondence

Sclerotherapy for the Treatment of Nodular Intraoral Kaposi's Sarcoma in Patients with AIDS

N Engl J Med 1993; 328:210-211January 21, 1993

Article

To the Editor:

Kaposi's sarcoma is a tumor of endothelial or spindle-cell origin classically described as a multicentric, pigmented angiosarcoma appearing on the lower extremities of older men of Jewish or Mediterranean ancestry1. Since the first report of Kaposi's sarcoma in homosexual and bisexual men in 1981, it has been recognized as the most common tumor among patients with disease due to the human immunodeficiency virus2 and is considered a diagnostic symptom of AIDS3. Kaposi's sarcoma commonly presents as a cutaneous lesion, but intraoral lesions are the initial manifestation in 20 percent of patients4. These oral lesions often have a nodular appearance, can readily be traumatized, and can interfere with mastication and speech. Treatment of intraoral Kaposi's sarcoma is warranted to reduce the size and the number of lesions. Radiation therapy is most commonly used, but it may induce severe mucositis. Chemotherapy, typically intralesional injections of vinblastine, is also used, but severe ulceration and pain may occur at the sites of injection. An alternative approach -- intralesional injection of the sclerosing agent sodium tetradecyl sulfate -- has been suggested5. Because of the vascular nature of these lesions, sclerosing solutions may be either an appropriate primary treatment or an adjunctive treatment to reduce the size of the lesions before radiotherapy.

We used intralesional injections of 3 percent sodium tetradecyl sulfate to treat 12 patients with AIDS who had 14 clinically or histologically confirmed intraoral lesions of Kaposi's sarcoma; 4 of the patients also had cutaneous lesions. Because of the potential for injection necrosis, no more than two intraoral lesions were treated at one time in any patient. The treated lesions, which ranged in size from 4 to 15 mm, changed color from purple to black immediately after the injections, but no associated pain or other untoward effects were reported. The injections were repeated in three days if the lesions had not decreased in size. Overall, their size decreased by an average of 80 percent within 14 to 21 days (Figure 1Figure 1Intraoral Lesions of Kaposi's Sarcoma in a Patient with AIDS, before (A) and Two Months after (B) Injection with Sodium Tetradecyl Sulfate.), and the lesions disappeared in four patients. Follow-up evaluation of all patients 24 weeks after treatment revealed no further clinical progression of the lesions.

Intraoral injection with sodium tetradecyl sulfate is a rapidly effective and well-tolerated treatment for nodular intraoral Kaposi's sarcoma and should be considered an alternative treatment for these lesions.

Brian C. Muzyka, D.M.D.
Michael Glick, D.M.D.
Temple University School of Dentistry, Philadelphia, PA 19140

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Citing Articles (8)

Citing Articles

1. 1

   Mahnaz Fatahzadeh. (2011) Kaposi sarcoma: review and medical management update. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
   CrossRef

2. 2

   AM Hegarty, SI Chaudhry, TA Hodgson. (2008) Oral healthcare for HIV-infected patients: an international perspective. Expert Opinion on Pharmacotherapy 9:3, 387-404
   CrossRef

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   Lorena Baccaglini, Jane C. Atkinson, Lauren L. Patton, Michael Glick, Giuseppe Ficarra, Douglas E. Peterson. (2007) Management of oral lesions in HIV-positive patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 103, S50.e1-S50.e23
   CrossRef

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   Leonard L. Lausten, Brett L. Ferguson, Bruce F. Barker, Charles M. Cobb. (2003) Oral Kaposi Sarcoma Associated with Severe Alveolar Bone Loss: Case Report and Review of the Literature. Journal of Periodontology 74:11, 1668-1675
   CrossRef

5. 5

   V. Ramı́rez-Amador, L. Esquivel-Pedraza, F. Lozada-Nur, E. De la Rosa-Garcı́a, P. Volkow-Fernández, L. Súchil-Bernal, A. Mohar. (2002) Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi’s sarcoma. A double blind, randomized clinical trial. Oral Oncology 38:5, 460-467
   CrossRef

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   Lauren L. Patton, Charles van der Horst. (1999) ORAL INFECTIONS AND OTHER MANIFESTATIONS OF HIV DISEASE. Infectious Disease Clinics of North America 13:4, 879-900
   CrossRef

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   Chulabhorn Pruksachatkunakorn, Kittchai Uruwannakul, Lertlakana Bhoopat. (1995) Kaposi Sarcoma in a Thai Boy with Acquired Immunodeficiency Syndrome. Pediatric Dermatology 12:3, 252-255
   CrossRef

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   Paulo Boente, Carlos Sampaio, MiguelA. Brandão, EdsonD. Moreira, Roberto Badaro, ThomasC. Jones. (1993) Local peri-lesional therapy with rhGM-CSF for Kaposi's sarcoma. The Lancet 341:8853, 1154
   CrossRef