Case Series Describes Link Between Koebner Phenomenon and Kaposi Sarcoma

Researchers characterized possible associations between Kaposi sarcoma (KS) and skin trauma history in a case series. They reported their findings recently in the Journal of Cutaneous Medicine and Surgery.

KS is a neoplasm that arises with human herpes virus 8 infection and in the presence of a variety of possible factors. Occasional case reports have described KS lesions appearing where there has been a prior cutaneous injury. “Traumatic and nontraumatic cutaneous injuries have a significant, often neglected role in the natural history of KS,” the researchers wrote in their report.

A phenomenon the researchers examined with a possible relationship to KS is the Koebner phenomenon, which “consists in the appearance of a dermatological lesion on previously unaffected skin after trauma; the new lesion matches the patient’s underlying cutaneous disease from a clinical and histological standpoint,” they wrote.

In this observational, retrospective study, the researchers, based in Italy, examined patient records since 2009 from their hospital service database, to evaluate recurrence of KS at the location of a prior cutaneous lesion that was either traumatic or nontraumatic in nature.

In their analysis, the researchers included patients with confirmed KS and photographic records of KS lesions located where there had been a prior cutaneous injury, and they evaluated clinical and KS-related characteristics in these patients. The researchers also performed a literature review using the PubMed database to identify articles describing Koebner phenomenon in KS.

Of 524 patients with KS identified in the hospital database, Koebner phenomenom developed in 31 patients (6%). Patients with Koebner phenomenon mostly (80%) had classic KS; 20% had iatrogenic KS. The diagnosis of KS had occurred at a mean age of 63.3 years in these patients, and 26% had not had a prior KS diagnosis whereas the remainder had recurrent KS.

The patients had a mean latency between injury and Koebner phenomenon of 24.2 months. The majority (77%) of them had Koebner phenomenon lesions located where there had been a prior surgical scar. Surgeries these patients had undergone had varied in type and location. Among the 31 patients, 4 (13%) had developed lesions after receiving electrochemotherapy (1 patient), laser therapy (2 patients), or cryotherapy (1 patient).

In their literature review of Koebner phenomenon in KS, the researchers had found 18 case reports. These involved 39 patients with Koebner phenomenon in KS located where there had been a prior biopsy, skin graft, burn scar, surgical wound, or dermatome associated with the varicella-zoster virus.

“In conclusion, we determined a much higher period prevalence of KP [Koebner phenomenon] in KS (31/524, 6%) than we expected according to previous reports in the literature,” the researchers wrote in their report. They recommended the avoidance of unnecessary injury to patients with KS, regarding, for example, therapeutic surgical excisions.

Reference

Brambilla L, Aromolo IF, Buffon S, Benaglia C, Tourlaki A. Koebner phenomenon in Kaposi’s sarcoma: a large single-center case series and review of current knowledge. J Cutan Med Surg. Published online January 18, 2023. doi:10.1177/12034754221149658