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Kim YC, Woo B, Kim HN, Kim KE, Jeon J, Kim C, Baek YS. Human papillomavirus detection rates in Bowen disease: correlation with pelvic and digital region involvement and specific p53 immunostaining patterns. Clin Exp Dermatol 2024; 49:848-858. [PMID: 38365318 DOI: 10.1093/ced/llae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The relationship between human papillomavirus (HPV) and Bowen disease (BD) is not fully understood. OBJECTIVES To investigate the differences in HPV detection rates in BD samples across various body regions and analyse the expression patterns of p53, p16 and Ki-67 in relation to HPV presence. METHODS Tissue samples from patients diagnosed with BD, confirmed through histopathology, were retrospectively collected. Next-generation sequencing was used for HPV DNA detection. Immunohistochemistry (IHC) for p16, p53 and Ki-67 was performed. RESULTS Out of 109 patients with BD, 21 (19.3%) were HPV-positive. All identified types were α-HPVs, with HPV-16 being the most common. The HPV detection rate was significantly higher in the pelvic (9/13, 69%, P < 0.001) and digital (5/10, 50%, P = 0.02) areas compared with those in the other regions. HPV presence was significantly correlated with p53 negativity (P = 0.002), the p53 'non-overexpression' IHC pattern (P < 0.001) and p16-p53 immunostain pattern discordance (P < 0.001). Conversely, there was no notable association between HPV presence and p16 positivity, the p16 IHC pattern or Ki-67 expression. CONCLUSIONS Our findings suggest the oncogenic role of sexually transmitted and genito-digitally transmitted α-HPVs in the pathogenesis of BD in pelvic and digital regions. GRAPHICAL ABSTRACT
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Affiliation(s)
- Young Chan Kim
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Been Woo
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Na Kim
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ko Eun Kim
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jiehyun Jeon
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chungyeul Kim
- Department of Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoo Sang Baek
- Departments of Dermatology and Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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2
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Bossart S, Daneluzzi C, Moor MB, Hirzel C, Heidemeyer K, Seyed Jafari SM, Hunger RE, Sidler D. HPV Vaccination in Immunosuppressed Patients with Established Skin Warts and Non-Melanoma Skin Cancer: A Single-Institutional Cohort Study. Vaccines (Basel) 2023; 11:1490. [PMID: 37766167 PMCID: PMC10535650 DOI: 10.3390/vaccines11091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
cSCC (cutaneous squamous cell carcinoma) and its precursors are a major cause of morbidity, especially in immunosuppressed patients, and are frequently associated with human papillomavirus (HPV) infections. The purpose of this study is to investigate the therapeutic potential of alpha-HPV vaccination for immunosuppressed patients with established cSCC and its precursors. In this retrospective study, all patients who received Gardasil-9®, a nonavalent HPV vaccine, as secondary prophylaxis were examined. Dermatologic interventions in both the pre- and post-vaccination periods were analyzed with zero-inflated Poisson regression and a proportional intensity model for repeated events with consideration of the clinically relevant cofactors. The hazard ratio for major dermatologic interventions was 0.27 (CI 0.14-0.51, p < 0.001) between pre- and post-Gardasil-9® intervention. Gardasil-9® vaccination showed good efficacy in reducing major dermatologic interventions even after correction of relevant cofactors and national COVID-19 caseloads during the observational period. Alpha-HPV vaccination may potentially cause a significant decrease in dermatologic interventions and overall mortality as well as healthcare costs in immunosuppressed patients with high skin tumor burden.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Cloé Daneluzzi
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Matthias B Moor
- Department of Nephrology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Daniel Sidler
- Department of Nephrology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
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Khayyati Kohnehshahri M, Sarkesh A, Mohamed Khosroshahi L, HajiEsmailPoor Z, Aghebati-Maleki A, Yousefi M, Aghebati-Maleki L. Current status of skin cancers with a focus on immunology and immunotherapy. Cancer Cell Int 2023; 23:174. [PMID: 37605149 PMCID: PMC10440946 DOI: 10.1186/s12935-023-03012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
Skin cancer is one of the most widespread cancers, with a significant global health effect. UV-induced DNA damage in skin cells triggers them to grow and proliferate out of control, resulting in cancer development. Two common types of skin cancer include melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC). Melanoma is the most lethal form of skin cancer, and NMSC includes basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and other forms. The incidence of skin cancer is increasing in part owing to a demographic shift toward an aging population, which is more prone to NMSC, imposing a considerable financial strain on public health services. The introduction of immunostimulatory approaches for cancer cell eradication has led to significant improvements in skin cancer treatment. Over the last three decades, monoclonal antibodies have been used as powerful human therapeutics besides scientific tools, and along with the development of monoclonal antibody production and design procedures from chimeric to humanized and then fully human monoclonal antibodies more than 6 monoclonal antibodies have been approved by the food and drug administration (FDA) and have been successful in skin cancer treatment. In this review, we will discuss the epidemiology, immunology, and therapeutic approaches of different types of skin cancer.
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Affiliation(s)
- Mahsa Khayyati Kohnehshahri
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
- Department of Cellular and Molecular Biotechnology, Institute of Biotechnology, Urmia University, Urmia, Iran
| | - Aila Sarkesh
- Student’s Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Ali Aghebati-Maleki
- Stem Cell Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Yousefi
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Neagu N, Dianzani C, Venuti A, Bonin S, Voidăzan S, Zalaudek I, Conforti C. The role of HPV in keratinocyte skin cancer development: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:40-46. [PMID: 36000380 DOI: 10.1111/jdv.18548] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
Keratinocyte skin cancers are the most frequent malignancy, accounting for approximately 30% of all cancers. Although beta genus HPV are the main etiologic agents for squamous cell carcinoma development in patients with epidermodysplasia verruciformis and organ transplant recipients, their role in non-melanoma skin cancer (NMSC) progression in the general population remains controversial. The aim of our review is to summarize current scientific data and to systematically analyse evidence regarding the role of HPV in keratinocyte skin cancers. A total of 2284 patients were included, of which 724 with actinic keratoses, 290 with Bowen's disease, 949 with cutaneous squamous cell carcinomas and 321 with keratoacanthomas. In the case of actinic keratoses, the majority were positive for beta (n = 372, 58.49%) and gamma HPV (n = 256, 40.25%) and only a few (n = 6, 0.94%) were positive for alpha subtypes. Similarly, most of the cutaneous squamous cell carcinomas were positive for beta (n = 248, 55.98%) and gamma HPV (n = 172, 33.82%) and 23 cases (2.42%) were positive for alpha subtypes. Bowen's disease lesions were mostly positive for beta (n = 43, 55.84%) and alpha HPV (n = 30, 38.96%), in contrast to the gamma genus (n = 4, 5.19%). Keratoacanthomas showed a high distribution among beta genus (n = 79, 50.31%) and an equal proportion between alpha (n = 39, 24.84%) and gamma (n = 39, 24.84%) genera. Studies published so far identifying HPV in keratinocyte skin cancers reflect the difference in detection methods rather than a type-specific tendency towards either actinic keratoses, Bowen's disease, squamous cell carcinoma or keratoacanthoma. On the other hand, recent evidence regarding the role of HPV vaccination in patients with non-melanoma skin cancer brings into perspective the idea of a beta-HPV vaccine or a combined alpha and beta-HPV vaccine that could be used as an adjuvant treatment measure in patients with recalcitrant non-melanoma skin cancer.
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Affiliation(s)
- Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Târgu Mureș, Romania.,Epidemiology Department, University of Medicine, Pharmacy, Science and Technology 'George Emil Palade' of Târgu Mureş, Târgu Mureș, Romania
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Aldo Venuti
- HPV-Unit, Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Serena Bonin
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Septimiu Voidăzan
- Epidemiology Department, University of Medicine, Pharmacy, Science and Technology 'George Emil Palade' of Târgu Mureş, Târgu Mureș, Romania
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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Wenande E, Bech-Thomsen N, Togsverd-Bo K, Haedersdal M. Off-Label 9-Valent Human Papillomavirus Vaccination for Actinic Keratosis: A Case Series. Case Rep Dermatol 2021; 13:457-463. [PMID: 34720918 PMCID: PMC8525264 DOI: 10.1159/000518666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background The suspected link between human papillomavirus (HPV) and the development of premalignant and malignant skin lesions remains inadequately examined in clinical settings. This case series describes HPV vaccination as an off-label adjuvant therapy for actinic keratosis (AK). Methods Twelve immunocompetent AK patients underwent HPV vaccination at a private dermatology clinic in Naestved, Denmark. Prior to vaccination, all patients demonstrated a high AK burden that required regular control visits. At 0, 2, and 6 months, the patients received an intramuscular injection of a commercially available 9-valent HPV vaccine. Concurrently, patients continued conventional AK therapies at 3-month intervals. Clinical response, consisting of reduction in AK number and general change in skin appearance, was assessed by a dermatologist over 12 months following first vaccination. Results All patients (mean age 76.2 years; 10 M and 2 F) completed the vaccine schedule. Overall, an average 85% reduction in total AK burden was recorded 12 months after beginning vaccination. Median AK burden thus fell from 56 (IQR: 44–80) to 13.5 (IQR: 1–18) lesions after 12 months. Lesion reduction was observable by the second inoculation at month 2 (34 AKs; IQR 22–80), continuing steadily until month 6 (15 AKs; IQR 5–30) and plateauing between 6 and 12 months. Clinically, HPV vaccination elicited fading of lesions' erythematous background after the first dose, often followed by sloughing of hyperkeratotic elements in subsequent weeks. Patients reported no adverse effects related to HPV vaccination. Conclusion This case series introduces the possibility that 9-valent HPV vaccination in combination with conventional treatments may be used as a therapeutic strategy for AK.
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Affiliation(s)
- Emily Wenande
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Katrine Togsverd-Bo
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
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Chen ML, Wang SH, Wei JCC, Yip HT, Hung YM, Chang R. The Impact of Human Papillomavirus Infection on Skin Cancer: A Population-Based Cohort Study. Oncologist 2020; 26:e473-e483. [PMID: 33191546 DOI: 10.1002/onco.13593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ming-Li Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shuo-Hsuan Wang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management office for Health Data, China Medical University, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Institute of Public Health (Biostatistics), National Yangming University, Taiwan
| | - Yao-Min Hung
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Tajen University, Pingtung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Recreation Sports Management, Tajen University, Pingtung, Taiwan
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Wenande E, Bech-Thomsen N, Haedersdal M. Reduction in actinic keratoses following 9-valent human papilloma virus vaccination. Dermatol Ther 2020; 33:e13454. [PMID: 32319136 DOI: 10.1111/dth.13454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Emily Wenande
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Development of a β-HPV vaccine: Updates on an emerging frontier of skin cancer prevention. J Clin Virol 2020; 126:104348. [PMID: 32334327 DOI: 10.1016/j.jcv.2020.104348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Abstract
Human papillomaviruses (HPVs) are small, non-enveloped, doublestranded DNA viruses. Over 200 subtypes of HPV have been identified, organized into five major genera. β-HPVs are a group of approximately 50 HPV subtypes that preferentially infect cutaneous sites. While α-HPVs are primarily responsible for genital lesions and mucosal cancers, growing evidence has established an association between β-HPVs and the development of cutaneous squamous cell carcinomas. Given this association, the development of a vaccine against β-HPVs has become an important topic of research; however, currently licensed vaccines only provide coverage for genital HPVs, leaving β-HPV infections and their associated skin cancers unaddressed. In this review, we summarize the current advances in β-HPV vaccine development, including progress made in preclinical testing and limited clinical data. We also discuss novel findings in the viral pathomechanisms involved in β-HPV cutaneous tumorigenesis that may play a large role in future vaccine development. We hope that synthesizing the available data and advances surrounding β- HPV vaccine development will not only lead to increased dedication to vaccine development, but also heightened awareness of a future vaccine among clinicians and the public.
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