Background. The prevalence of Kaposi’s sarcoma (KS), an AIDS-defining illness, has increased in parallel with the HIV/AIDS epidemic. The presence of violaceous skin lesions should raise suspicion of KS. However, especially on dark skin, KS mimics a variety of non-KS skin conditions. Histologically, there is a wide range of expressions of KS and a large number of mimickers. For all these reasons, a HHV-8 immunohistochemically biopsy-proven diagnosis of KS should be the gold standard. Methods. Prospective study of 490 consecutive skin biopsies from the general community in the Limpopo Province of South Africa, from April 2010 through December 2011. Results. The clinical discordance rate (over-/underdiagnosis of KS) was 30.5%; the histological discordance rate was 9.2%. Conclusion. Because of the magnitude of diagnostic error, both clinical and histological, all clinical lesions suspicious of KS should be biopsied and HHV-8 LAN-1 immunophenotyped. 1. Introduction Kaposi’s sarcoma (KS) became an AIDS-defining illness at the outset of the human-immunodeficiency-virus-(HIV-) induced acquired immunodeficiency syndrome (AIDS) endemic and pandemic [1–3]. There has been a striking increase in incidence of KS in both men and women compatible with the evolution of the AIDS epidemic in sub-Saharan Africa [4, 5]. In HIV/AIDS endemic regions such as sub-Saharan Africa, purplish/violaceous skin lesions should arise a high degree of awareness and suspicion of KS. However, the clinical picture of KS may mimic a variety of non-KS lesions. Furthermore, the histopathological expression of KS encompasses a large number of mimics too [6]. Finally, not all KS are HIV-related [3]. Sub-Saharan Africa in general and South Africa in particular are at the epicenter of the HIV/AIDS endemic. Although the prevalence rates vary somehow according to the sources, it was estimated that in 2010 it infected 17.8 percent of the South African population and up to 19.7 percent of females aged between 15 and 45 years [7]. Because of the opt-in policy for testing (voluntary counseling and testing) and the arguable widespread risk of discrimination after disclosure of positivity necessary for access to antiretroviral treatment (ART), an undefined portion of the population’s HIV status remains undiagnosed, unknown, or undisclosed [8]. The human herpes virus-8 (HHV-8) or Kaposi’s sarcoma associated herpes virus (KSHV) was identified as the infectious agent of all types of KS (classic/sporadic, iatrogenic/posttransplant, endemic/African, and AIDS-related/HIV-associated) [9]. The latent nuclear
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