NEOPLASMS

Oral Manifestations of HIV infection
By Drs. Deborah Greenspan and John S. Greenspan

Kaposi's Sarcoma

People with AIDS-associated Kaposi's sarcoma (KS) frequently have oral lesions that present as red or purple patches or swellings. The palate is the most common site but lesions also occur on the gingiva, tongue, and oropharynx. KS is usually asymptomatic, but occasionally becomes painful because of ulceration or infection. Bulky gingival lesions that show when the patient smiles or talks may be of concern for cosmetic reasons and may also interfere with oral hygiene. Good oral hygiene and professional cleaning of teeth are, therefore, important in the management of oral KS. Small, well-localized lesions on the palate or gingiva are usually good candidates for treatment with intralesional vinblastine or surgical removal; the carbon dioxide laser is also sometimes useful in removing such lesions. Small lesions may be treated on several occasions to achieve the best results. Large lesions may respond better to radiation therapy, either in one-dose treatment or fractionated treatment delivered for ten to twelve days. Some patients experience episodes of mucositis during therapy and xerostomia is sometimes a problem; both usually improve after therapy. Systemic chemotherapy is indicated for widespread or disseminated disease. Bacillary angiomatosis may mimic KS, but diagnosis is made from a biopsy from the lesion, examined with the Warthin-Starry stain.

Lymphoma

Oral lesions of AIDS-associated lymphoma may be the first presentation of that tumor. The lesions include firm masses and persistent ulcers. Diagnosis is made from a biopsy, for these lesions may mimic other forms of welling or ulceration. AIDS-associated lymphomas in the mouth are usually large B-cell immunoblastic in type; T-cell lymphomas are also seen, albeit rarely, The oral lesions are treated as part of the overall management.