Introduction

Kaposi sarcoma (KS) is a type of cancer that starts in the blood vessels and is linked to a virus called Human Herpesvirus 8 (HHV-8). It often first shows up on the skin as unusual marks or patches, but it can also affect the lining of the mouth and other internal organs. Spotting these skin changes early can make a big difference, as it means treatment can begin sooner and outcomes are often better.³

KS is more common in people with weakened immune systems. This includes those living with HIV/AIDS, people who have had organ transplants and take immune-suppressing medicines, and people from areas of the world where HHV-8 is more widespread.

This article will guide you through how KS skin changes look, how they progress over time, and why getting medical advice early is so important.³

 What are Kaposi sarcoma lesions?

A “lesion” simply means a patch of skin that looks different from the surrounding skin. In Kaposi sarcoma, these patches can be flat or raised and are often pink, purple, or brown in colour. The unusual colouring comes from extra blood vessels growing in the skin, which is caused by the HHV-8 virus.¹

Unlike other common skin changes, KS lesions do not fade or heal on their own. They tend to stay and progress unless treated. People with weakened immune systems, such as those taking medicines that lower immunity after a transplant, are more likely to develop KS lesions.

Appearance of KS skin lesions

Kaposi sarcoma skin lesions can look quite different from person to person:

• Colour: They may appear pink, red, purple, brown, or even black, depending on the person’s natural skin tone
• Texture and shape: At first, they may look like flat patches, but over time they can become raised, forming firm plaques or lump-like nodules. The surface can be smooth or slightly rough
• Size and number: Some people develop just one or two small lesions, while others may notice many. These can gradually merge into larger areas
• Location: They are most often found on the legs, feet, face, mouth, or genital area. In more advanced cases, internal organs such as the lungs or digestive tract can also be affected²

One important thing to know is that, unlike many other skin conditions, KS lesions do not simply heal or disappear with time. They usually continue to grow or spread unless properly treated.

Progression of lesions over time

Kaposi sarcoma lesions usually develop in three main stages:

• Patch stage: These start out as flat, painless spots that are reddish or purple in colour. At first, they may look very similar to a simple bruise
• Plaque stage: Over time, the spots may become raised and firmer. They can spread out and merge with nearby lesions, creating larger areas⁶
• Nodular stage: In later stages, the lesions form dome-shaped lumps. These may sometimes break open (ulcerate), bleed, or become painful. Swelling of the legs or genital area can also happen if the lymphatic system (which helps drain fluid) becomes blocked⁵

How quickly KS lesions change depends on the person’s immune system and whether they are receiving treatment. People with strong immunity often notice slower changes, while those with weaker immunity may see lesions worsen more quickly.

When to seek medical advice

You should see a doctor if you notice:

• Skin changes or spots that don’t heal or go away on their own
• Lesions that keep growing, start to bleed, or cause swelling
• New lesions appearing inside the mouth or in the genital area

It’s especially important for people with weaker immune systems—such as those living with HIV/AIDS or those who have had an organ transplant—to get checked early. The sooner KS is diagnosed, the sooner treatment can begin, which helps prevent complications and leads to better outcomes.³

Diagnosis and treatment

Diagnosing KS can be tricky because its skin lesions often look like other skin problems.

Doctors usually begin with a physical examination, but this alone is not enough to confirm KS. To be certain, they will take a small sample of the skin (a biopsy) and examine it under a microscope.

If there’s a chance that KS has spread to internal organs, further tests such as X-rays or CT scans may be used to see how far the disease has progressed.³

Treatment

Treatment options include:

• Antiretroviral therapy (ART): In people living with HIV, ART can often shrink or even make the lesions disappear
• Systemic therapy: If the disease is more widespread, chemotherapy or newer treatments that boost the immune system (immunotherapy) may be used¹

The choice of treatment depends on how advanced the KS is and the person’s overall health.

Diagnostic challenges and delays in Kaposi sarcoma

Early diagnosis of KS is very important for successful treatment. Unfortunately, many people face delays in getting the right diagnosis. A study in Kenya highlighted both patient-related and healthcare-related reasons for this.⁹

Some challenges faced by patients include:

• Not being aware of what KS is or what the signs look like
• Turning first to traditional remedies rather than medical care
• Fear of stigma or discrimination, especially if KS is linked to HIV

Challenges within the healthcare system include:

• Doctors sometimes mistake KS for another skin condition
• Examinations not being carried out thoroughly
• A lack of medical equipment or resources in some clinics

By raising awareness, reducing stigma, and improving healthcare services, people can be diagnosed earlier. This means they can start treatment sooner and have better outcomes.

Psychological and social impact of KS skin lesions

Because KS often appears on the skin — especially on visible areas like the face, arms, or hands — it can have a big effect on how someone sees themselves. Many people feel self-conscious, and research has shown that this can lead to anxiety and depression.

When KS is linked to HIV/AIDS, the social challenges can be even harder. People may face stigma, not only because of the condition itself but also because of assumptions others make about HIV. This can lead to isolation, difficulties at work, and avoiding social situations out of fear of judgement.

What can help?

• Emotional support and counselling should be offered as part of treatment, to help people cope with the impact on their mental health
• Community education can also reduce stigma and encourage compassion, so people with KS feel more supported rather than excluded⁸

FAQs

Are KS lesions painful?

Usually, KS lesions do not hurt at first. They are mostly painless in the early stages. However, as they grow or ulcerate, they can become sore, bleed, or feel uncomfortable.

Can KS lesions go away on their own?

No, Kaposi sarcoma lesions will not disappear without medical treatment. For people living with HIV, effective antiretroviral therapy (ART) can sometimes help lesions shrink or regress, but most cases require specific treatment.

How do I know if a lesion is KS or something else, like a bruise or mole?

KS lesions are different from common bruises or moles. They usually appear pink, red, purple, or brown, and they do not fade over time. Bruises typically heal, and moles stay the same shape and colour. KS lesions also tend to grow and may join together if untreated.

Is Kaposi sarcoma contagious?

The virus that can cause KS (HHV-8) can be spread between people, but KS itself is not contagious. You cannot “catch” the tumour from someone who has it.

Can Kaposi sarcoma be cured?

The chances of curing KS depend on how early it is detected. Early-stage lesions are easier to treat and may be fully resolved. Advanced KS can be treated, but it may require more intensive therapy, including chemotherapy or immunotherapy.

Does having KS mean I have HIV/AIDS?

Not necessarily. KS is more common in people with weakened immune systems, including those living with HIV or taking immunosuppressive medications, but it can also occur in other settings. KS alone is not a definitive sign of HIV/AIDS.

Summary

Kaposi sarcoma is a type of tumour that usually affects the skin, but it can also involve internal organs and mucous membranes. The skin lesions caused by KS are quite distinctive and progress over time if untreated. They usually start as flat patches (patch stage), then rise into thicker plaques (plaque stage), and may eventually form dome-shaped nodules (nodular stage). Early lesions are often painless, but as they grow, they can bleed, ulcerate, and become uncomfortable.

Diagnosis begins with noticing these skin changes, but a biopsy is needed to confirm KS. Because the lesions can spread internally to organs like the liver, lungs, and mucous membranes, imaging tests such as X-rays or CT scans may be required to assess the extent of the disease.⁷

Living with KS can also have emotional and social impacts. The visible lesions can affect self-image and confidence, while social stigma — especially when KS is associated with HIV/AIDS — can lead to isolation, anxiety, and depression. Including psychological support or counselling in the treatment plan can help people manage these challenges and maintain their mental well-being.⁸

Early recognition, timely medical care, and emotional support are key to managing Kaposi sarcoma. Understanding what to look out for, seeking help promptly, and having access to support can make a meaningful difference in outcomes and quality of life.