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Huang AYY, Lin CL, Chen GS, Hu SCS. Clinical features of Kaposi's sarcoma: experience from a Taiwanese medical center. Int J Dermatol 2019; 58:1388-1397. [PMID: 31102268 DOI: 10.1111/ijd.14476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/10/2019] [Accepted: 04/11/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most of the previous reports regarding the clinical features of Kaposi's sarcoma (KS) have been performed in Western and African countries. The clinical characteristics of KS have not been well defined in Han Chinese or Taiwanese patients. In this study, we analyzed the clinical features of KS patients in a Taiwanese medical center. METHODS Medical records from Kaohsiung Medical University Hospital over the past 20 years (1996-2016) were comprehensively reviewed. RESULTS There were 55 patients with KS (50 males and 5 females), including 37 patients (67%) with classic disease, 17 patients (31%) with AIDS-associated disease, and one patient (2%) with immunosuppressive medication-related disease. The average age was 58.7 years (range 20-87 years), and the average age was younger for AIDS patients (33.8 years) compared with non-AIDS patients (69.8 years). Among patients with classic KS, lesions were mostly localized to the lower extremities, whereas AIDS-associated KS patients were more likely to develop disseminated skin lesions, skin lesions on atypical sites (head and neck, trunk), and extracutaneous involvement (particularly oral cavity). The most common underlying diseases were diabetes mellitus (20% of patients) and hepatitis B (15% patients), and 38% of KS patients were smokers. Patients with AIDS-associated KS usually responded well to chemotherapy, whereas only 32% of patients with non-AIDS-associated KS showed complete response to radiotherapy. CONCLUSIONS The findings of the current study will serve as important references for clinicians in the diagnosis of KS and may form the basis for the implementation of KS clinical practice guidelines in Taiwan.
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Affiliation(s)
- Alice Ya-Yun Huang
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Ling Lin
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gwo-Shing Chen
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Stephen Chu-Sung Hu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Forae GD, Obaseki DE. Trends and Histopathological Patterns of Kaposi Sarcoma at The University of Benin Teaching Hospital, Benin City, Nigeria. Oman Med J 2018; 33:337-341. [PMID: 30038734 PMCID: PMC6047182 DOI: 10.5001/omj.2018.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/01/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Kaposi sarcoma (KS) shows greater geographic variation in incidence than almost any other vascular tumor globally. KS is common in parts of Sub-Saharan Africa accounting for 9% of all diagnosed cancer cases in men in the early 1990's in Uganda and Zaire. KS is classified by the World Health Organization as a borderline vascular tumor. We aimed to determine the trends and histopathological patterns of KS as seen in the University of Benin Teaching Hospital in Benin City, Nigeria, and to compare with similar work in other centers. METHODS We conducted a retrospective analysis of all histologically confirmed KS seen over a 20-year period at the Pathology Department of the University of Benin Teaching Hospital. RESULTS A total of 269 histologically diagnosed vascular tumors were analyzed. Of these, borderline tumors constituted 30.9% (n = 83). KS constituted 79 (95.2%) out of the 83 borderline vascular tumors. Out of the 79 cases of KS, 76 (96.2%) cases were confirmed in HIV/AIDS patients on highly active antiretroviral therapy. The male to female ratio of KS was 1.1:1.0 while the mean age was 39.2±3.6 years. There was a sharp rise in the trend of KS from 2005 to a peak in 2008. The leg and foot region was the most common site of occurrence. There were two cases seen in the cervical lymph node in the pediatric age group. CONCLUSIONS KS was the most common borderline vascular tumor with almost all cases confirmed as HIV/AIDS patients. The mean age of presentation was in the fourth decade of life with a sharp rise in its incidence from 2005 with a peak incidence in 2008. This was followed by a slight decline from 2009 to 2013. Mixed and nodular KS were the most frequently encountered types and patterns, respectively.
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Affiliation(s)
- Gerald Dafe Forae
- Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria
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Ogoina D, Onyemelukwe GC, Musa BOP, Babadoko A. Human Herpesvirus 8 Infections and AIDS-Associated Kaposi Sarcoma in Zaria, Northern Nigeria. ACTA ACUST UNITED AC 2016; 10:43-8. [PMID: 21368014 DOI: 10.1177/1545109710387300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES Studies on human herpesvirus 8 (HHV8) infection in patients with AIDS-associated Kaposi sarcoma (AIDS-KS), from Nigeria are lacking. We examined the seroprevalence of HHV8 infection in patients with AIDS-KS presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, and also described their clinical presentation. METHODS A total of 20 (11 males and 9 females) histologically confirmed adults with AIDS-KS were recruited consecutively in 2007. The clinical types of lesions, associated diseases, and the AIDS clinical trial group staging of AIDS-KS were noted. Anti-lytic HHV8 antibodies were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Kaposi sarcoma skin lesions were diverse but mostly nodules (19 cases) and papules (16). Majority (18 cases) had poor risk AIDS-KS, with 10 (50%) patients having concomitant opportunistic infections and 3 (15%) patients having generalized skin lesions. Females had a more severe disease. Seventeen patients (85%) were HHV8-seropositive. CONCLUSION AIDS-KS is associated with high HHV8 infection and presents with a variety of skin manifestations that are often aggressive, advanced, and worse in females.
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Affiliation(s)
- Dimie Ogoina
- Immunology unit, Department of Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria,
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Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study. J Skin Cancer 2016; 2016:9368023. [PMID: 27034839 PMCID: PMC4808559 DOI: 10.1155/2016/9368023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/13/2016] [Accepted: 02/14/2016] [Indexed: 12/04/2022] Open
Abstract
Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients' hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS.
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Abstract
BACKGROUND This paper reports on a 6-year study (April 2006 to April 2012) and a follow-up of a 9-month baseline survey of the pattern of dermatoses in Calabar, the capital of Cross River State in southern Nigeria. Prior to the time of this study, this region had not benefited from the services of a resident dermatologist for over a century. METHODS Data on the age, gender, and diagnoses of 1307 consecutive new patients attending the relatively new dermatology clinic at the University of Calabar Teaching Hospital during the study period were obtained and analyzed. Most diagnoses were based on clinical findings but were supported by relevant laboratory investigations and histopathologic examinations when necessary. RESULTS The male : female ratio of patients was 1 : 1.5. The mean ± standard deviation age of the patients was 27.7 ± 17.2 years (range: 4 weeks to 84 years). A total of 1459 diagnoses were recorded; 143 patients had more than one dermatosis. Diagnoses were broadly divided into 10 groups. Allergic/hypersensitivity diseases represented the most common group (30.4%), followed by infections/infestations (28.9%). A comparison of this study with others from various geopolitical zones of Nigeria revealed some similarities. Dermatophytosis and acne were consistent reasons for visits to dermatologists in all zones. CONCLUSIONS Despite the wide spectrum of dermatoses observed, a small number of diseases account for a sizeable percentage of diagnoses. The pattern of dermatoses in Calabar is similar to that in other parts of the country. Climate and socioeconomic factors are synergistic in causing dermatoses that remain a major cause of morbidity in all age groups and both genders across Nigeria.
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Affiliation(s)
- Eshan B Henshaw
- Dermatology Unit, Department of Medicine, University of Calabar, Calabar, Nigeria
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Bouzidi H, Gallouj S, Amraoui N, Mernissi FZ, Harmouch T. [Classic Kaposi botriomycome disease-like: a diagnostic trap]. Pan Afr Med J 2014; 17:283. [PMID: 25317231 PMCID: PMC4194204 DOI: 10.11604/pamj.2014.17.283.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/14/2014] [Indexed: 12/01/2022] Open
Abstract
La maladie de kaposi (MK) botriomycome-like et une variante clinique et anatomopathologique rare de la MK, rapportée aussi bien dans la forme classique et épidémique de la MK. C'est une entité difficile à diagnostiquer car ses caractéristiques cliniques et histologiques englobent à la fois celles du botriomycome et de la MK. En plus du contexte clinique l’étude histologique et immunohistochimique restent primordiales pour établir son diagnostic. Nous rapportons un cas de MK botriomycome-like assez particulier pas sa localisation et son siège unique.
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Affiliation(s)
- Hanae Bouzidi
- Service de Dermatologie-Vénérologie, CHU Hassan II, Fès, Maroc
| | - Salim Gallouj
- Service de Dermatologie-Vénérologie, CHU Hassan II, Fès, Maroc
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Bouzidi H, Gallouj S, Krich S, Mernissi FZ. [Classic Kaposi disease with adrenal involvement: a new case]. Pan Afr Med J 2014; 17:234. [PMID: 25170378 PMCID: PMC4145280 DOI: 10.11604/pamj.2014.17.234.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
La maladie de kaposi est une pathologie connue généralement dans sa forme épidémique associée au sida ou celle endémique présente dans l'Afrique subsaharienne. La forme classique de cette maladie ou dite également méditerranéenne n'est pas bien connue étant assez rare. Elle touche les hommes âgés HIV séronégatifs originaires de l'Europe centrale, l'Europe de l'Est et les méditerranéens. Elle se manifeste essentiellement par une atteinte cutanée, éventuellement muqueuse mais l'atteinte viscérale reste moins fréquente, dominée par l'atteinte osseuse, pulmonaire et gastrique. La localisation surrénalienne est inhabituelle et très rare. Nous rapportons ce nouveau cas pour mettre le point sur cette pathologie rare et signaler cette localisation atypique.
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Affiliation(s)
- Hanae Bouzidi
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
| | - Salim Gallouj
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
| | - Sanae Krich
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
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Saturday Morning Science Programs: A Model to Increase Diversity in the Biosciences. J Natl Med Assoc 2012; 104:377-83. [DOI: 10.1016/s0027-9684(15)30180-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mosam A, Uldrick TS, Shaik F, Carrara H, Aboobaker J, Coovadia H. An evaluation of the early effects of a combination antiretroviral therapy programme on the management of AIDS-associated Kaposi's sarcoma in KwaZulu-Natal, South Africa. Int J STD AIDS 2012; 22:671-3. [PMID: 22096054 DOI: 10.1258/ijsa.2009.009145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Roll-out of combination antiretroviral therapy (cART) in South Africa should impact on AIDS-associated Kaposi's sarcoma (KS). Government provision began in 2003, with 23% coverage for World Health Organization (WHO) stage IV AIDS in 2006. To assess the effect of cART availability on KS management, we evaluated records from 701 KS patients seen at a tertiary oncology centre in KwaZulu-Natal, South Africa, from 1995 to 2006. Associations between cART use and measures of KS care were evaluated. cART availability was 0% prior to 2001, 9.6% (2001-2003) and 44% (2004-2006). Documentation of HIV status increased incrementally from 65% to 92%. cART was associated with chemotherapy administration: 56% on cART versus 17% not on cART (P < 0.001); and less loss to follow-up, 13% on cART versus 38% not on cART (P < 0.001). cART availability improves the care of AIDS-associated KS. Further increases in cART availability for this population are needed in South Africa.
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Affiliation(s)
- A Mosam
- Department of Dermatology, Nelson R Mandela School of Medicine, CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
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Ibekwe P, Ogunbiyi O, Ogun G, George O. Kaposi's sarcoma in HIV-infected women and men in Nigeria. AIDS Patient Care STDS 2011; 25:635-7. [PMID: 21967494 DOI: 10.1089/apc.2011.0122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Kaposi's sarcoma (KS) in women with HIV infection is observed to have increased from recent studies. To understand the gender-related differences of AIDS-KS in Nigeria, we conducted a prospective study of the clinical, virologic, and immunologic features of newly diagnosed AIDS-KS patients. Prevalence was similar in both genders. There were differences in the distribution of the lesions and the CD4 count in women was significantly lower.
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Affiliation(s)
- P.U. Ibekwe
- University College Hospital Ibadan, Ibadan, Nigeria
| | | | - G.O. Ogun
- University College Hospital Ibadan, Ibadan, Nigeria
| | - O.A. George
- University College Hospital Ibadan, Ibadan, Nigeria
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Agaba PA, Sule HM, Ojoh RO, Hassan Z, Apena L, Mu'azu MA, Badung B, Agbaji OO, Idoko JA, Kanki P. Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria. Int J STD AIDS 2009; 20:410-3. [PMID: 19451327 DOI: 10.1258/ijsa.2008.008353] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.
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Affiliation(s)
- P A Agaba
- AIDS Prevention Initiative Nigeria (APIN) Centre, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
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Asuquo ME, Udosen AM, Ikpeme IA, Ngim NE, Otei OO, Ebughe G, Bassey EE. Cutaneous squamous cell carcinoma in Calabar, southern Nigeria. Clin Exp Dermatol 2009; 34:870-3. [PMID: 19456790 DOI: 10.1111/j.1365-2230.2009.03243.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria. METHODS All patients with histological diagnosis of SCC presenting to the University of Calabar Teaching Hospital during the period January 2005 to December 2006 were evaluated. RESULTS In total, 10 patients (6 male, 4 female, mean age 39.3 years, range 16-62) were seen. There were six patients (60%) with Marjolin's ulcer (MU) of the leg, with a male:female ratio of 5:1 and a latency period of 14.7 years, with trauma as the leading cause of injury. The other four patients (40%) had non-MU SCC. Two of these four patients (one man, one woman) were albino, and had lesions that involved the head. The other two patients were both women, and had vulval lesions. All 10 patients had delayed hospital admission, after poor results with topical herbal treatment. After hospital treatment, the results were satisfactory in three patients (two with MU and the male albino patient). The other seven patients had generally poor results from treatment, which comprised various combinations of excision, adjuvant chemotherapy and radiation. CONCLUSION Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.
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Affiliation(s)
- M E Asuquo
- Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
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Asuquo M, Umana A, Otei O, Bassey I, Ebughe G. Kaposi sarcoma in calabar, southern Nigeria. Oman Med J 2009; 24:33-6. [PMID: 22303507 DOI: 10.5001/omj.2009.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 01/25/2009] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There has been an increase in the prevalence of Kaposi sarcoma (KS) with the emergence of Human Immunodeficiency Virus (HIV). METHODS Patients with histologic diagnosis of KS seen in the University of Calabar Teaching Hospital, Calabar between January 2007 and December 2008 were studied. Diagnosis of HIV was based on enzyme linked immunosorbent assay (ELISA). RESULTS In total, 15 patients (10 males, 5 females, M: F=2:1) presented with KS and accounted for 33.0% of total skin malignancy and ranked second after squamous cell carcinoma, 42.0%. Their ages ranged from 5 and 60 years (mean 37.5 years). Twelve patients (M=8, F=4), 80%, were HIV seropositive, while 3 (M=2, F=1) were HIV seronegative. The lower limb was the commonest affected site, 57.9%. CONCLUSION The most common clinical type was HIV related KS. Ignorance, sociocultural beliefs, poverty, late presentation were underlying issues.
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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Pitche PT, Kombate K, Owono F, Tchangai-Walla K. Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases. Int J Dermatol 2007; 46 Suppl 1:42-4. [DOI: 10.1111/j.1365-4632.2007.03464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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