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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Kaposi&#8217;s Sarcoma &#40;KS&#41; is a rare&#44; Human Herpes Virus 8 &#40;HHV-8&#41; associated angioproliferative low-grade mesenchymal neoplasm&#44; characterized by cutaneous patches&#44; plaques&#44; and nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy and Ultrasonography &#40;US&#41; are useful complementary techniques in the study of KS lesions&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> the latter also providing valuable guidance for intralesional treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Correlation between dermoscopic&#44; and ultrasonographic findings has not been reported in KS&#46; Herein&#44; we describe two cases of treatment-na&#239;ve&#44; medium-to-large-sized KS nodules with complex architectural and vascular features&#44; assessed by means of dermoscopy&#44; and the US&#46; We speculate that non-invasive recognition of complex KS lesional structure may aid in the adequate management of intralesional chemotherapy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Patient 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">An eighty-two-year-old male with biopsy-proven&#44; long-standing&#44; classic KS and an otherwise unremarkable medical history complained of a newly formed lesion on the left heel&#44; clinically appearing as a violaceous 9<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm nodule&#44; with a peripheral scaly collarette&#46; Dermoscopy showed two violaceus&#44; large vascular areas separated by a white grayish structureless area &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#8210;b&#41;&#46; At the B-mode examination&#44; the lesion presented an oval hypoechoic structure with well-demarcated edges and with an inner median normoechoic septum delimitating two separate subunits&#46; Color Doppler examination revealed that the subunits were supplied by two different blood vessels&#46; Moreover&#44; their blood flow did not communicate to a significant degree &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c&#47;Video 1 &#8211; supplementary material&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">A sixty-three-year-old male with biopsy-proven&#44; long-standing&#44; classic KS and an unremarkable history came in for consultation due to the appearance of an angiomatous 7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm nodule on his right arm&#44; presenting with a smooth surface and a faded border&#46; Dermoscopy highlighted two violaceous structureless areas on a pinkish-brownish background&#44; divided by a somewhat paler area laying in-between&#59; moreover&#44; no vascular structures could be appreciated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>d&#8210;e&#41;&#46; On B-mode ultrasonography&#44; the nodule presented two contiguous subunits and a septum-like structure could be noted in the center of the lesion&#46; eFlow mode images confirmed the presence of distinct vascular peduncles supplying each subunit &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>f&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Adequate for size intralesional treatment with vincristine was offered in both cases&#44; meaning the quantity of vincristine infiltrated was proportional to the largest diameter of the nodule&#44; as measured clinically and dermoscopically&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> More specifically&#44; 0&#46;09<span class="elsevierStyleHsp" style=""></span>mL and 0&#46;07<span class="elsevierStyleHsp" style=""></span>mL of vincristine sulfate &#40;Vincristina Teva&#44; Teva Italia Srl&#174;&#44; Assago&#44; Italy&#41; at a concentration of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;mL were administered in Patients 1 and 2&#44; respectively&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Complete response was achieved in both cases&#44; with no clinical evidence of recurrence in 12 months of follow-up&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Intralesional drug administration is particularly advantageous in nodular KS lesions&#44; leveraging the presence of a pseudo-capsule for drug containment and concentration&#46; Therapeutic failures and even paradoxical worsening in the days following the injection are rare but have been described&#46; Known predisposing factors include large &#40;7&#8210;8<span class="elsevierStyleHsp" style=""></span>mm&#41; lesional size and plantar and lateral plantar localization of the nodule&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Septations delimiting autonomous vascular spaces within nodular KS lesions may theoretically lead to drug entrapment&#44; relative over-filling&#44; and subsequent inflammatory activation in surrounding tissues upon treatment&#46; We presented two KS cases in which dermoscopy revealed whitish grayish structureless areas corresponding to septa upon ultrasonography&#46; Further research is required to demonstrate a causal relationship between structural complexity and a proportion of the therapeutic failures observed with intralesional chemotherapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although no definite recommendations can be given at this time&#44; we argue that it would be cautious to screen nodular KS lesions for dermoscopic features suggestive of septations prior to intralesional treatment&#46; Should any be noticed&#44; a sonographic study as well as US-guided vincristine administration could be offered&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Gianluca Nazzaro&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Athanasia Tourlaki&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Carlo Alberto Maronese&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Enrico Zelin&#58; Approval of the final version of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Emanuela Passoni&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Lucia Brambilla&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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