ABSTRACT: Eur J Dermatol. 2003 Jan-Feb;13(1):83-6. Links

Staging of classic Kaposi's sarcoma: a useful tool for therapeutic choices.
* Brambilla L, Boneschi V, Taglioni M, Ferrucci S.
Department of Dermatology, University of Milan, IRCCS Ospedale Maggiore, Via Pace, 9, Italy. aldo.finzi@unimi.it

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.
ABSTRACT By Results :
“Tables I summrises our staging system which includes four clinical stages : Stage I (maculo-nodular):small isolated angiomatous
maculae and/or nodules, prevently localised in lower limbs; Stage II (infiltrative) : prevalent violet-grey plaque lesions involving wide
areas of lower limbs, sometimes associated with a few nodules ; Stage III(florid): exuberant angiomatous plaques and nodules, often
ulcerated, involving one or more limbs; Stage IV (disseminated) : presence of a significant number of angiomatous plaques and
nodules involving other skin districts in addition to the limbs.
TABLE I – Mediterranean Kaposi’s Sarcoma staging

Stage Skin lesions Localitation Behaviour Evolution Complications *

I-Maculo-noduar (+ v) Nodules and/or macules Lower limbs Non aggresive Slow (A)
Rapid (B)
Lymphedema
Lynphorrea

II-Infiltrative (+ v) Plaques Lower limbs Locally aggressive Slow (A)
Rapid (B)
Hemorrhage
Pain

III-Florid (+ v) Angiomatous nodules and Limbs,lower prevalent Locally aggressive Slow (A)
plaques Rapid (B)
Functional
impairment

IV-Disseminated (+ v) Angiomatous nodules and Limbs, , trunck, head Disseminated aggressive Rapid (B) Ulceration
plaques

Legend:
V : visceral involvement (pharinge-oral cavità, gastroenteric tract, lymph nodes,bone marrow, lungs)
Rapid : increase in total number of plaques in the three months following an examination
* : All of them prevalent in stage III and IV , lymphedema and lymphorrea often observed in stageII, lymphedema and hemorrhage
sometimes present in stage I