Staging of classic Kaposi's sarcoma: A useful tool for therapeutic choices

Three hundred patients with classic Kaposi's sarcoma (CKS) have attended our Department of Dermatology over a period of 20 years. Many of them have been treated by systemic chemotherapy with good responses. Due to the highly variable clinical evolution of the disease, it was, however, often difficult for us to decide whether or not to treat elderly patients. We therefore attempted to establish a new staging system based on objective criteria that more closely follow the clinical variability of CKS and make the therapeutic choices easier. The proposed staging system comprises 4 stages, each further divided according to the speed of disease evolution and presence of complications that can severely impair the quality of life. The application of this staging system to our patients has shown that evolution is prevalently slow in the maculo-nodular and infiltrative stages I and II and faster during the florid and disseminated stages III and IV. Complications are mainly present in the rapidly evolving florid and disseminated stages, with visceral involvement in the more aggressive forms. Based on these findings, we are employing systemic therapy in the florid and disseminated stages and in the infiltrative stage only in case of rapidly evolving or slowly evolving but complicated disease.