Persistently recurring mediterranean Kaposi's sarcoma on skin grafts

In May of 1985, we first saw a 79-year-old woman with Mediterranean Kaposi's sarcoma (KS). It had first appeared in 1983 on the left leg and thigh. In March 1984, the lesions were treated with high-velocity electrons (9MeV) to four contiguous fields (25 x 30 cm, 25 x 30 cm, 12 x 14 cm, and 11 x 14 cm), a total dose of 60 Gy per field, to the left extremity (3rd distal pretibial region, dorsal foot and region of the Achilles tendon). When we first saw the patient, she had a chronic radiodermatitis on the lower third of the left leg, with an extensive and deep ulcer (10 x 15 cm), exposing the tendon insertion of the anterior tibial muscle (Fig. 1). Karposi's sarcoma which had previously regressed after radiotherapy, had also recurred in the form of nodules on the pretibial region along the edge of the ulcer and on the left plantar region. The nodules were treated with intralesional infiltration of vincristine (VCR) according to our usual schedule²⁵ and complete remission (VCR) of all lesions was obtained within 3 months. After the KS nodules disappeared, a successful I total-thickness graft for the ulcer was performed. In April 1987, some biopsy-proven nodules of KS (Fig. 2) appeared on the site of the graft; they regressed within 2 months after local infiltration of VCR. After about 18 months, there were ulcerating flourishing lesions of KS that had developed at the same site (Fig. 3). At this time the lesions were resistant to intralesional treatment, but sensitive to vinblastine (VLB), 9 mg IV, every 4 weeks, with complete remission in March, 1990. In January 1990, a second radiodermatitis ulcer appeared (Fig. 4), confined to the upper margin of the first graft; this required another graft in which a new Kaposi's nodule arose 3 months later (Fig. 5); the nodules regressed after intralesional treatment with VCR. In December 1990, a third ulcer appeared in the region of the left Achilles heel; it was covered with a skin graft that did not survive. In September 1991, the patient was given another graft at the same site with partially favorable results. Three months after the procedure, there was again a KS recurrence in the graft site; this is at present in CR after intralesional treatment with VCR.