Medical history and physical exam: Your doctor will take your medical history to learn about any past illnesses, operations, your sexual history, and other possible exposures to KSHV and HIV. The doctor will ask you about symptoms and about any skin tumors you have noticed. The doctor will examine your skin thoroughly as well as give you a complete physical exam. Sometimes KS lesions develop inside the rectum (the part of the large intestine just inside the anus). A doctor may be able to detect such lesions during an exam with a gloved finger.
Biopsy: Skin lesions caused by KS can resemble other kinds of skin disorders, inflammation, bacterial or fungal infections, non-Hodgkin lymphoma, or a benign tumor of the blood vessels (hemangioma). For that reason, the doctor will want to take a small sample of tissue (biopsy) from the lesion and send it to a lab to be analyzed. Under a microscope, KS cells usually have a distinctive shape and pattern of arrangement. Sometimes, though, early lesions may not reveal the characteristic cell patterns necessary to positively diagnose KS.
For skin lesions, the doctor will usually perform a punch biopsy, which removes a small round piece of tissue usually about 1/6-inch in diameter. Or the doctor may remove the entire lesion in a procedure called an excisional biopsy.
Imaging studies: The most important imaging study in KS is the chest x-ray. This can tell if KS is in the lungs.
Endoscopy: In an endoscopy procedure, the doctor uses a thin, flexible, lighted tube called an endoscope to look into your lower intestine or your stomach for lesions. This is done while you are sedated. It is also possible to biopsy these lesions using small surgical instruments operated through the endoscope.
Bronchoscopy: In this procedure a doctor looks into the breathing tubes of the lungs with a thin flexible instrument. The patient is put to sleep with light anesthesia. This procedure is usually done if you are coughing up blood. If the doctor sees a KS lesion, it will be biopsied.
Sometimes AIDS-related KS affects other organs, such as the liver, spleen, heart, or bone marrow, but in just about all cases the disease can be diagnosed from biopsies of other tissues, such as skin, lungs, or intestines.
