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Cinzia Masini, MD; Pawel G. Fuchs, PhD; Fabrizio Gabrielli, MD; Sabine Stark, DBiol; Francesco Sera, DStat; Miriam Ploner; Carmelo Franco Melchi, MD; Grazia Primavera, MD; Giulio Pirchio, MD; Orietta Picconi, DStat; Pierpaolo Petasecca, MD; Maria Sofia Cattaruzza, MD, MSc; Herbert J. Pfister, PhD; Damiano Abeni, MD, MPH

Arch Dermatol. 2003;139:890-894.

Objective  The aim of our study was to evaluate human papillomavirus (HPV) infection as a risk factor for cutaneous squamous cell carcinoma (SCC) in immunocompetent individuals.

Design  Hospital-based case-control study.

Setting  Referral center for dermatologic diseases for central and southern Italy.

Participants  Consecutive patients with histologically confirmed cutaneous SCC (n = 46) and control subjects (n = 84) chosen by frequency matching (age and sex) among patients admitted with unrelated diseases.

Main Outcome Measure  Infection with epidermodysplasia verruciformis–related HPV types, blindly assessed by serologic testing (viruslike particle enzyme-linked immunosorbent assay). Information was obtained on known potentially confounding risk factors (family history, history and signs of sun exposure, and pigmentary traits) and on history of HPV-related lesions and diseases, assessed by interview and examination by a dermatologist.

Results  Positive serologic findings for HPV type 8 were associated with SCC (odds ratio, 3.2; 95% confidence interval, 1.3-7.9) independently of other risk factors, whereas positive serologic findings for HPV type 15 were negatively associated with SCC (odds ratio, 0.4; 95% confidence interval, 0.2-0.9). Other variables significantly associated with the tumor were family history of skin cancer, professional or recreational sun exposure, light eye color, high number of solar keratoses and seborrheic keratoses on the body surface, and residency in radon-emitting buildings.

Conclusions  Positive serologic findings for HPV type 8 are associated with SCC occurrence in immunocompetent individuals. Viral infection could act as a cofactor in the tumor development, along with genetic predisposition, solar radiation, and other environmental exposures. If confirmed, these findings could open new perspectives for treatment and prevention of SCC.

From the Clinical Epidemiology Unit (Drs Masini, Sera, Picconi, Cattaruzza, and Abeni), Department of Plastic Surgery (Dr Gabrielli), Department of Clinical Dermatology (Drs Melchi and Primavera), and Laboratory (Drs Pirchio and Petasecca), Istituto Dermopatico dell'Immacolata, Rome, Italy; Institut fuer Virologie der Universitaet zu Koeln, Cologne, Germany (Drs Fuchs, Stark, and Pfister and Ms Ploner); and Department of Public Health, Università "La Sapienza," Rome (Dr Cattaruzza). The authors have no relevant financial interest in this article. Dr Fuchs died July 10, 2002.

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