Individuals living with Human Immunodeficiency Virus (HIV) face a higher likelihood of developing certain skin cancers. This increased risk is directly linked to the virus’s effect on the body’s defense systems. Understanding this relationship is the first step toward recognizing potential signs and taking protective measures. This article explores the biological reasons for this vulnerability, identifies the specific skin cancers of concern, and outlines strategies for prevention and medical care.
The Connection Between HIV and the Immune System
A healthy immune system constantly patrols the body for threats, including abnormal cells that could become cancerous. This protective function, known as immune surveillance, is carried out by specialized cells that identify and eliminate potential dangers before they can develop into malignancies. This process is a fundamental aspect of how the body maintains its cellular integrity and prevents the uncontrolled growth that characterizes cancer.
HIV compromises this defense system by targeting and destroying CD4+ T-cells, a type of white blood cell that coordinates the body’s immune response. As HIV progresses, the number of these cells declines, which is measured as the CD4 count. A low CD4 count signifies a weakened immune system, or immunosuppression, which impairs the body’s ability to conduct effective immune surveillance.
A compromised immune system also struggles to control other cancer-causing viruses, known as oncogenic viruses. When the immune system is suppressed by HIV, these oncogenic viruses can become active and promote the development of specific malignancies. This dual impact establishes the biological foundation for the increased cancer risk in people with HIV.
Common Skin Cancers in People with HIV
One of the most significant skin cancers associated with HIV is Kaposi sarcoma (KS). Caused by the Human Herpesvirus-8 (HHV-8), it is an AIDS-defining illness, meaning its presence in someone with HIV can lead to a diagnosis of Acquired Immunodeficiency Syndrome (AIDS). KS is characterized by the appearance of distinct lesions on the skin, which can also develop in mucous membranes, lymph nodes, and internal organs. These lesions present as patches, plaques, or firm nodules that range in color from pink to purple and do not blanch when pressed.
Non-melanoma skin cancers, specifically basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are also more common in individuals with HIV. BCC often appears as a pearly or waxy bump or as a flat, flesh-colored or brown scar-like lesion. SCC can present as a firm, red nodule, a flat lesion with a scaly, crusted surface, or a sore that repeatedly heals and re-opens. The risk for SCC is particularly elevated due to the immune system’s reduced ability to control Human Papillomavirus (HPV).
Melanoma, while less common than non-melanoma skin cancers, represents a more dangerous form of skin cancer. It develops from melanocytes, the cells that produce pigment, and can appear as a new mole or a change in an existing one. A helpful tool for identification is the “ABCDEs” of melanoma:
- Asymmetry: One half of the spot does not match the other.
- Border: The edges are irregular, scalloped, or poorly defined.
- Color: The color includes varied shades of brown, tan, or black.
- Diameter: The spot is usually larger than 6mm, the size of a pencil eraser.
- Evolving: A mole or lesion looks different from the rest or is changing in size, shape, or color.
Though the direct link between HIV and melanoma is less pronounced than with KS or SCC, immune suppression may still play a role in its progression.
Risk Factors and Prevention
The most effective preventative strategy is strict adherence to antiretroviral therapy (ART), as the primary risk factor is a compromised immune system. ART suppresses HIV replication, allowing the immune system to recover and the CD4 count to rise. A stronger immune system can better perform its surveillance duties, controlling oncogenic viruses and destroying precancerous cells before they can progress.
Reducing exposure to ultraviolet (UV) radiation from the sun is another preventative measure. This includes using broad-spectrum sunscreen with a high SPF, wearing sun-protective clothing like long-sleeved shirts and wide-brimmed hats, and avoiding direct sun during peak hours (10 a.m. to 4 p.m.). These practices help protect the skin from UV damage, which is a leading cause of most skin cancers in the general population and an additive risk for those with HIV.
Regularly checking your own skin for any new or changing spots is a proactive step. You should become familiar with your skin’s normal landscape of moles and freckles to identify suspicious developments. These self-examinations should be complemented by routine professional dermatological screenings to ensure early detection.
Diagnosis and Medical Management
The diagnostic process for a potential skin cancer begins when an individual or their healthcare provider notices a suspicious lesion. A doctor will perform a physical examination, assessing the spot’s size, shape, color, and texture. If the lesion exhibits characteristics suggestive of malignancy, a skin biopsy is performed, where a small tissue sample is removed and sent to a laboratory for analysis.
Once a diagnosis of skin cancer is confirmed, treatment is tailored to the cancer’s type, size, location, and stage. Common treatments include:
- Surgical excision to remove the tumor.
- Cryotherapy (freezing the lesion with liquid nitrogen).
- Topical medications that can be applied directly to the skin.
- Radiation therapy or systemic treatments like chemotherapy for more advanced cancers.
Managing skin cancer in a person with HIV requires a collaborative approach between different medical specialists. The care team often includes an infectious disease doctor to manage the HIV, alongside a dermatologist or oncologist who oversees the cancer treatment. This coordinated care ensures that the chosen cancer therapies do not negatively interact with the patient’s ART regimen and that the patient’s immune status is considered at every stage of treatment.