Blunt Dissection Technique for the Removal of Kaposi’s Sarcoma

According to Gonzalez-Martinez et al, [1] surgery is the treatment of choice for the removal of nodular Kaposi’s sarcoma. While the literature documents surgical excision as a treatment option, the authors were unable to find any mention of blunt dissection as a surgical option in the treatment of nodular Kaposi’s sarcoma. The authors have found blunt dissection to be a useful technique for retrieving biopsy material and treating the cutaneous nodular form of Kaposi’s sarcoma (Fig. 1). The nodule seen in Kaposi’s sarcoma is amenable to blunt dissection because of the lesion’s histologic circumscription and demarcation from surrounding dermis (Fig. 2).

The authors prefer to use a Freer periosteal elevator for blunt dissection of Kaposi’s sarcoma. The elevator allows removal of the nodular lesion without the need for sharp surgical excision. This is especially important when lesions are removed from the sole, where the potential for scarring should be minimized. With the elevator, deep pressure or tension is exerted on the instrument. This allows the borders of the nodule to be easily freed (Fig. 3). Once the borders of the nodule are released, the entire lesion can be scooped out in one motion. The cutaneous lesion is bluntly excised down to the level of the superficial fascia to ensure complete removal of the nodule. The superficial fascia can be easily distinguished from surrounding tissues by its glossy, white appearance (Fig. 4). [2] Once the lesion is removed, the affected area can heal by secondary intention. The authors have found no recurrence of the lesion at the site from which it was removed.

The blunt dissection technique for the removal of nodular Kaposi’s sarcoma offers the advantages of complete extirpation and preservation of the lesion for pathologic examination with a minimum of scarring.