Purpose: Squamous cell carcinoma (SCC) confers significantly increased mortality in both solid organ transplant recipients (OTR) and the immunocompetent nonwhite population. In the latter, a majority of these lesions are found in sun-protected genital areas. Viral induction, specifically human papilloma virus (HPV) is hypothesized to play a role in the pathophysiology of these lesions. Our aim is to elucidate the etiology of genital SCC in the nonwhite OTR population.

Methods: Thorough genital examination including the groin, perineum, and perianal area was performed in all nonwhite OTR who visited the Drexel Dermatology Center for Transplant Patients from 2/1/16 and 11/28/16. All lesions suspicious for malignancy were biopsied. Lesions that were diagnosed as SCC were sent for HPV DNA PCR typing.

Results: Fifty-one nonwhite OTR were examined. Fourteen percent (N=7) of patients- 5 Black, 1 Hispanic, and 1 Asian- were diagnosed with a total of 10 SCCIS and 0 SCC in the genital region. Seventy percent (N=7) of the lesions were positive for high-risk HPV. Six demonstrated HPV types 16/18, the seventh was positive for high-risk HPV DNA but could not be further typed. None of the lesions demonstrated high-risk types 31/33. Two patients exhibited multiple SCCIS lesions that were positive for high-risk HPV. Six patients received kidney transplants and one received a heart and lung transplant. The median time from transplant to diagnosis of skin cancer was 6 years.

Conclusion: Our data supports the hypothesis that HPV infection is a significant etiological factor in the development of anogenital SCC lesions in the nonwhite population. The majority of lesions in our nonwhite OTR typed positive for high-risk HPV, specifically 16/18. Thorough genital examination is an imperative part of posttransplant skin examination in nonwhite OTR. Further studies are warranted to develop risk stratification screening, preventative measures, and assess the potential utility of pre-transplant HPV vaccination in the prevention of cutaneous SCC in the nonwhite OTR population.

CITATION INFORMATION: Nadhan K, Larijani M, Ogrich L, Shaver C, Doyle A, Chung C. High-Risk Human Papillomavirus Associated with Genital Squamous Cell Carcinoma in Nonwhite Organ Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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