Kaposi sarcoma, a low-grade malignant vascular neoplasm associated with human herpes virus (HHV8), is classified into four subtypes: epidemic (HIV-related), classic, endemic, and iatrogenic. Dermatopathologists play a crucial role in confirming the diagnosis; histologic features include infiltrative slit-like vascular spaces with complex architecture. Treatment strategies vary based on subtype and disease severity and may include both local and systemic therapies. In this retrospective, single-center cohort study, we report 26 patients diagnosed with Kaposi sarcoma from 2014 to 2025, comparing prevalence, clinical presentation, treatment, and outcomes between HIV-associated and classic subtypes. The mean age at diagnosis was 64.9 years, with a predominance of male patients (92.3%) and Caucasians (53.8%). The HIV-associated subtype was slightly more common (57.6%) than the classic subtype (42.3%). The classic subtype showed exclusively cutaneous involvement, while the HIV-associated subtype exhibited a mixed pattern of cutaneous (60.0%) and extracutaneous (40.0%) involvement. Antiviral therapy was the most common treatment modality (57.6%) and was used exclusively in the HIV-associated group. Other treatments included radiation (11.5%), local therapy (7.6%), systemic chemotherapy (3.8%), and 23.1% of patients received multimodal therapy. Of note, patients with the classic subtype had a higher recurrence rate (45.5%) compared to the HIV-associated subtype (6.7%) and were more likely to require multiple treatment modalities.  In the era of antiretroviral therapy, epidemiologic shifts may result in other subtypes becoming more prevalent in the general population, and dermatopathologists and dermatologists must remain aware of the potential of this diagnosis to occur with increasing frequency in the absence of concurrent HIV.