BRIEF COMMUNICATION
Risk of Classic Kaposi Sarcoma with Residential Exposure
to Volcanic and Related Soils in Sicily
COLLEEN PELSER, CARMELO DAZZI, BARRY I. GRAUBARD, CARMELA LAURIA,
FRANCESCO VITALE, AND JAMES J. GOEDERT
PURPOSE: Before AIDS, endemic (African) Kaposi sarcoma (KS) was noted to occur in volcanic areas
and was postulated to result from dirt chronically embedded in the skin of the lower extremities. The
primary cause of all KS types is KS-associated herpesvirus (KSHV) infection, but cofactors contribute to
the neoplasia. We investigated whether residential exposure to volcanic or related soils was associated
with the risk of classic Kaposi sarcoma (cKS) in Sicily.
METHODS: Risk of incident cKS (NZ141) compared with population-based KSHV seropositive
controls (NZ123) was estimated for residential exposure to four types of soil, categorized with maps
from the European Soil Database and direct surveying. Questionnaire data provided covariates.
RESULTS: Residents in communities high in luvisols were approximately 2.7 times more likely to have
cKS than those in communities with no luvisols. Risk was not specific for cKS on the limbs, but it was
elevated approximately four- to five-fold with frequent bathing or tap water drinking in communities
with high luvisols. Risk was unrelated to communities high in andosols, tephra, or clay soils.
CONCLUSIONS: Iron and alumino-silicate clay, major components of luvisols, may increase cKS risk,
but formal investigation and consideration of other soil types and exposures are needed.
Ann Epidemiol 2009;19:597–601. Published by Elsevier, Inc.
KEY WORDS: Herpesviridae, Kaposi Sarcoma, Italy, Soils.