Human papillomavirus and the incidence of nonmelanoma and melanoma skin cancer using cervical conization as a surrogate marker: a nationwide population-based Danish cohort study

The Impact of Human Papillomavirus Infection on Skin Cancer: A Population-Based Cohort Study

BACKGROUND

This study investigated the correlation between a history of human papillomavirus (HPV) infection and skin cancer risk.

MATERIALS AND METHODS

The study cohort comprised 26,919 patients with newly diagnosed HPV infection between 2000 and 2012; with the use of computer-generated numbers, patients without previous HPV infection were randomly selected as the comparison cohort. The patients in the HPV infection cohort were matched to comparison individuals at a 1:4 ratio by demographic characteristics and comorbidities. All study individuals were followed up until they developed skin cancer, withdrew from the National Health Insurance program, were lost to follow-up, or until the end of 2013. The primary outcome was subsequent skin cancer development. Cox proportional hazards regression analysis was used to analyze the risk of skin cancer with hazard ratios (HRs) and 95% confidence intervals (CIs) between the HPV and control cohort.

RESULTS

The adjusted HR of skin cancer for patients with HPV relative to controls was 2.45 after adjusting sex, age and comorbidities. (95% CI, 1.44-4.18, p < .01). The subgroup analysis indicated that a patient with HPV infection had a significantly greater risk of skin cancer if they were aged >40 years. Notably, a risk of skin cancer was found in the group diagnosed with HPV within the first 5 years after the index date (adjusted HR, 3.12; with 95% CI, 1.58-5.54). Sensitivity analysis by propensity score, matching with balanced sex, age, and comorbidities, showed consistent results.

CONCLUSION

A history of HPV infection is associated with the development of subsequent skin cancer in Taiwanese subjects, and the risk wanes 5 years later.

IMPLICATIONS FOR PRACTICE

In this Taiwan nationwide cohort study, there was a 2.45-fold increased risk of developing new-onset skin cancers for patients with incident human papillomavirus (HPV) infection, compared with the matched controls. Furthermore, the risk was noticeably significant among patients aged >40 years. A prominent risk of skin cancers was found in the group diagnosed with HPV within the first 5 years after the index date in this study. The results of this analysis may raise consensus on the effect of HPV infection on the risk of skin cancers. Clinicians are encouraged to implement prudently on the differential diagnosis of skin cancers and HPV prevention and treatment, especially in older patients.

Conjunctival intraepithelial neoplasia and carcinoma: distinct clinical and histological features in relation to human papilloma virus status

AIMS

Human papillomavirus (HPV) is considered a causative agent for the development of a broad range of human carcinomas. The role of HPV in the development of conjunctival intraepithelial neoplasia (CIN) and carcinoma (cSCC) remains unclear. The purpose of the present study was to investigate the HPV prevalence in a nationwide cohort and to describe clinical and histopathological features in relation to HPV status.

METHODS

All cases of CIN and cSCC in Denmark from 1980 to 2016 were included. We combined p16 immunohistochemistry (IHC), RNA in situ hybridisation (RNA ISH) and HPV DNA PCR to detect HPV. The results were correlated to clinical and histopathological parameters.

RESULTS

One hundred twelve primary tumours and 33 recurrent tumours were included for HPV analysis. Twenty-four (21%) of the primary tumours were HPV positive by PCR. Eighteen of out 19 HPV-positive tumours were positive by RNA ISH. HPV16 was the most prevalent genotype (n=18, 75%). The patients with HPV-positive tumours were significantly younger (mean difference 11.5 years, 95% CI 5.2 to 17.9, p=0.0005) and had a higher recurrence compared with patients with HPV-negative tumours (HR 2.30, 95% CI 1.02 to 5.21, p=0.046). The HPV-positive tumours were associated with a positive p16 IHC and a non-keratinising morphology.

CONCLUSION

We describe distinct clinical and histopathological features associated with HPV status in cSCC. The finding of transcriptionally active HPV in this material lends support to a causal role of HPV in a subset of cSCC.

Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007

INTRODUCTION

The aim of this study was to analyze trends in the incidence of skin cancer worldwide, in Europe, and in Spain between 1978 and 2007.

MATERIAL AND METHODS

Skin cancer incidence and trends for the period 1978 to 2007 were investigated using the age- and sex-standardized rates (per 100,000 population) published in the Cancer Incidence in Five Continents series.

RESULTS

The incidence of cutaneous melanoma increased progressively from 1978 to 2002 but decreased in the last period analyzed (2003-2007). The highest rates were reported for Australia and the white population in Hawaii. In Spain, the incidence of melanoma tripled in both sexes over the study period. The incidence of nonmelanoma skin cancer also increased between 1978 and 2007, and higher rates were detected in men. The highest incidence rates were recorded in Australia, Brazil, and among the European inhabitants of Zimbabwe. In Spain, the incidence of nonmelanoma skin cancer had doubled or tripled in both sexes by the end of the study period.

LIMITATIONS

We were unable to analyze data for the period 2008 to 2012 due to a 5-year delay in the publication of data by the International Agency for Research on Cancer.

CONCLUSIONS

The rise in the incidence of skin cancer, assessed using age-standardized rates, suggests that primary prevention measures are insufficient or inappropriate. The reduction in the incidence of cutaneous melanoma in Australia between 2003 and 2007 suggests that the preventive strategies initiated several decades earlier in that country have been effective.