https://doi.org/10.1177/1203475419847954 Journal of Cutaneous Medicine and Surgery 1–8 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1203475419847954 jcms.sagepub.com Introduction Kaposi sarcoma (KS) is a vascular neoplasm arising from endothelial cells. It is still controversial whether it is a neo- plastic or hyperplastic process. Conversely, human herpes- virus 8 is the well-known agent held responsible for its etiology. Four types of KS are identified: classic, endemic, epidemic, and iatrogenic. Classic KS is generally seen in older people of Eastern European or Jewish origin and does not have a tendency to involve multiple organs. 1 It usually remains limited to the skin. Localization and dis- semination of lesions, checking whether concomitant com- plaints, such as pain or lymphedema, are reported, and the patient’s immunological status are the main factors to be considered while deciding optimal treatment. 2 In classic- type KS, radiotherapy, cryotherapy, and surgery are the most commonly used treatment methods as this type is limited to the skin. Systemic treatments, such as IFN- alpha, bleomycin, and liposomal daunorubicin, may be the best approaches only if there is progressive disseminated disease. Patients who have classic KS, which is not a life-threatening condition, are usually elderly people, and considering their age, systemic agents are not easily initi- ated for them even if they have disseminated disease. Cryotherapy, laser therapy, and intralesional immunosup- pressive drugs are effective local treatment methods for disease limited to the skin. 1-4 Cryotherapy has been used extensively in dermatology for benign or malignant skin tumours, warts, and some vas- cular lesions as it is inexpensive, safe, and easily applied. Cryotherapy is useful in KS, particularly if the lesions are small or located at different anatomical sites. 5-7 In our depart- ment, it is the preferred first-line treatment of KS. However, Original Article 847954CMS XX X 10.1177/1203475419847954Journal of Cutaneous Medicine and SurgeryOdyakmaz Demirsoy et al. research-article 2019 1 Department of Dermatology, Kocaeli University School of Medicine, Turkey 2 Department of Public Health, Kocaeli University School of Medicine, Turkey Corresponding Author: Evren Odyakmaz Demirsoy, Kocaeli University School of Medicine, Department of Dermatology, Kocaeli, 41380, Turkey Email: evrenodyakmaz@yahoo.com Imiquimod 5% Cream Versus Cryotherapy in Classic Kaposi Sarcoma Evren Odyakmaz Demirsoy 1 , Dilek Bayramgürler 1 , Çiğdem Çağlayan 2 , Nilgün Bilen 1 , Aysun Şikar Aktürk 1 , and Rebiay Kıran 1 Abstract Background: Classic Kaposi sarcoma usually remains on the skin and has a slow progression; thus, local treatment methods are preferable. Imiquimod is an immunomodulatory agent with antiviral, antitumoural, and antiangiogenic properties that is expedient against Kaposi sarcoma. Objectives: We aimed to clarify whether imiquimod is effective on classic Kaposi sarcoma lesions by comparing imiquimod treatment with cryotherapy, which is the most-used treatment method in our department for this disease. Method: Patients with classic Kaposi sarcoma were included. All lesions of each patient were evaluated and measured by the blinded investigator considering infiltration and surface diameters. Then, lesions were categorized into 2 groups by the other investigator (nonblinded), and imiquimod 5% cream was administered 3 times per week without occlusion in 1 group. Cryotherapy was performed every 3 weeks in the other group. All lesions were reevaluated and measured at the end of 12 weeks by the blinded investigator. Initial and last measurements were compared between the treatment methods. Results: Fifty lesions of 8 patients were included in this study. Imiquimod and cryotherapy were applied to 26 and 24 lesions, respectively. At the end of the study, statistically significant decreases were detected in all scores between weeks 0 and 12 with both treatment methods. Mean percentages of change in scores were not significantly different between the methods. Conclusions: Based on a limited number of patients and lesions treated, we believe imiquimod may be a suitable option to use for the treatment of classic Kaposi sarcoma. Keywords Cryotherapy, imiquimod, Kaposi sarcoma, treatment