OMFS-0134Malignant lesionsOncologyadvancedHard palate and gingiva

Purple palatal lesions in an HIV-positive patient

38-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Purple patches on the palate that are enlarging

§Medical & dental history

01HIV positive, poor antiretroviral adherence, CD4 count 92 cells/uL
02Recurrent oral candidiasis
03Irregular attendance; generalised periodontitis

§Clinical examination

01Multiple violaceous macules and nodules on the hard palate and maxillary gingiva
02Some lesions ulcerated with contact bleeding
03Concomitant pseudomembranous candidiasis
04Generalised lymphadenopathy

§ figuresFigures (2)

Kaposi Sarcoma — clinical image: This HIV-positive patient presented with an intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection. This AIDS patient exhibited a CD4+ T-cell count <200, and a high viral load. Initially, the KS les — Fig. 1This HIV-positive patient presented with an intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection. This AIDS patient exhibited a CD4+ T-cell count <200, and a high viral load. Initially, the KS les
“Kaposi’s sarcoma intraoral AIDS 072 lores” · Photo Credit: Sol Silverman, Jr., D.D.S. Content Providers: CDC/ Sol Silverman, · Public domain · Wikimedia Commons

Kaposi Sarcoma — clinical image: This HIV patient presented with labial and gingival Kaposi’s sarcoma secondary to his AIDS infection which included the maxilla. In approximately 7.5-10 percent of AIDS patients display signs of oral Kaposi’s sarcoma, an — Fig. 2This HIV patient presented with labial and gingival Kaposi’s sarcoma secondary to his AIDS infection which included the maxilla. In approximately 7.5-10 percent of AIDS patients display signs of oral Kaposi’s sarcoma, an
“KaposisSarcomaFromCDC03-18-06” · Photo Credit: Sol Silverman, Jr., D.D.S. Content Providers: CDC/ Sol Silverman, · Public domain · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Kaposi Sarcoma figures pending faculty review.

§Differential diagnosis

Kaposi sarcomaViolaceous multifocal lesions, HHV-8, immunosuppression

Bacillary angiomatosisBartonella, responds to antibiotics

Oral melanomaBrown-black rather than violaceous, usually solitary

Pyogenic granulomaSolitary, bright red, gingival, trauma-related

§Final diagnosis

AIDS-associated (epidemic) Kaposi sarcoma of the oral cavity

Multifocal violaceous lesions in a profoundly immunosuppressed patient are Kaposi sarcoma until biopsy proves otherwise; HHV-8 (LANA-1) immunostaining confirms it and separates it from vascular mimics.

§Investigations

01Incisional biopsy with HHV-8 LANA-1 immunohistochemistry
02CD4 count and HIV viral load
03Staging for visceral and cutaneous involvement
04Screening for other opportunistic infections

§Treatment plan

01Optimise antiretroviral therapy — the single most effective intervention
02Local therapy: intralesional vinblastine or radiotherapy for symptomatic oral lesions
03Systemic chemotherapy for widespread or visceral disease
04Treat candidiasis and provide periodontal care

§Histopathology report

Proliferation of spindle cells forming slit-like vascular spaces with extravasated erythrocytes and haemosiderin, plasma cell infiltrate. HHV-8 LANA-1 positive. Kaposi sarcoma.

§Follow-up & outcome

01Marked regression of oral lesions after 6 months of effective antiretroviral therapy
02CD4 rose to 310 cells/uL
03Residual lesions treated with intralesional vinblastine

§Clinical pearls / learning points

01Oral Kaposi sarcoma may be the first presentation of undiagnosed HIV — offer testing.
02Immune reconstitution alone often produces substantial regression.
03Palatal and gingival sites are the most frequent oral locations.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Head and Neck Tumours

5th Edition — Volume 9

WHO Classification of Tumours Editorial Board · 2022

The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 2
L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified

WHO Classification of Head and Neck Tumours5th Edition — Volume 9

WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022

The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.

DOI: Identifier not availablePMID: Identifier not available

View source

Reference #2L1 · ClassificationWHO / Classification Verified

WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available

View source

Histopathology References

Reference #5L6 · TextbookHistopathology References Unverified

Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008