Plantar Kaposi Sarcoma in an Immunocompromised Patient: Surgical Management and Durable Local Disease Control

Background Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus-8 and immunosuppression. Management in HIV-positive patients typically emphasizes systemic therapy given the multifocal nature of the disease. Localized surgical intervention is often reserved for symptomatic or refractory lesions, particularly when located in weight-bearing regions where ulceration and infection may precipitate limb-threatening complications. Evidence guiding surgical thresholds and postoperative wound strategies for plantar KS remains limited. Case Presentation A 56-year-old immunocompromised patient with a longstanding HIV infection (CD4 count 378 cells/µL) with past medical history of diabetes mellitus, prior methicillin-resistant Staphylococcus aureus colonization, and a 16-year history of recurrent KS presented in June 2018 with a painful violaceous lesion involving the right plantar foot. The lesion was ulcerative in nature and measured 2.0 cm width × 2.0 cm length × 1.0 cm depth and was positive for peri-wound erythema, raising concern for limb-threatening infection. Magnetic resonance imaging (MRI) confirmed the presence of Kaposi sarcoma confined to the plantar fascial envelope, without osseous involvement. Discussion: This case demonstrates durable site-specific control of plantar KS following margin-negative excision in a patient with failed prior systemic therapy and persistent ongoing immunosuppression. The absence of recurrence over a five-year interval represents the longest localized remission in this patient’s disease course. Standard wound-healing strategies promote angiogenesis and cellular proliferation, processes that overlap with KS pathophysiology. In the absence of established wound care guidelines for oncologic wounds, perioperative management required a strategic approach that supported wound healing. Conclusions: Plantar KS in immunocompromised patients presents unique limb-preservation challenges that extend beyond standard oncologic systemic control. This case highlights the critical role of tailored operative decision-making in situations where plantar disease compromises mobility and jeopardizes limb preservation. Additional investigation is warranted to better delineate operative criteria and to establish standardized, evidence-informed wound management approaches for malignant plantar lesions in immunocompromised populations.