Kaposi sarcoma is the most common HIV-associated neoplasm, frequently presenting and highlight the histomorphological spectrum of oral Kaposi sarcoma. One hundred and thirty-five cases diagnosed between 1990 and 2011 were retrieved from the archives of the Oral and Dental Hospital of the University of Pretoria, South Africa. Following histological review, each case was placed into one of seven categories based on the predominant pattern of growth. These histological divisions included lesions designated as solid, lymphangioma-like, telangiectatic, desmoplastic, lymphangiectatic, ecchymotic and anaplastic. The presence of co-existent pathology was identified in 25 cases, largely represented by superimposed candidiasis. Concomitant cytomegalovirus and non-necrotizing granulomatous inflammation were also observed. Whilst the prognostic significance of these variants is yet to be determined, the appreciation and recognition of such morphologic diversity remains essential in distinguishing these lesions from possible mimickers.