Cutaneous warts and risk of cancer
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Cutaneous Warts, Human Papillomavirus (HPV), and Cancer Risk
HPV Infection, Cutaneous Warts, and Skin Cancer Risk
Cutaneous warts are benign skin lesions caused by infection with human papillomavirus (HPV), particularly types from the beta genus. While most warts are harmless, there is evidence that HPV infection is associated with an increased risk of developing epithelial skin cancers, especially cutaneous squamous cell carcinoma (cSCC) 216. This risk is particularly pronounced in individuals with compromised immune systems, such as organ transplant recipients and those undergoing chronic immunosuppression, where the prevalence of warts and skin cancers is significantly higher 178.
Immunosuppression, Warts, and Cancer in High-Risk Populations
Organ transplant recipients and other immunosuppressed individuals are at a much higher risk for both persistent HPV infections and the development of skin cancers. In these populations, the number of HPV-induced warts is strongly associated with the risk of developing skin cancer, and the onset of warts often precedes the diagnosis of skin cancer by several years 178. Studies have shown that a high viral DNA load of beta-HPV in the skin correlates with a significant risk for precancerous lesions and skin cancer, explaining the up to 250-fold increased risk in organ transplant recipients . Additionally, in some cases, neoplastic transformation of warts into cancerous lesions has been observed .
HPV Genotypes, Warts, and Malignancy
Most common cutaneous warts are caused by low-risk HPV types and rarely progress to malignancy. However, high-risk HPV types are more commonly associated with mucosal cancers, such as cervical cancer, and can also be detected in some skin cancers . Genital HPV infection, in particular, is a known risk factor for cervical neoplasia, but common warts on the skin are generally considered benign and infrequently convert to cancer .
Seborrhoeic Warts and Skin Cancer Association
In renal transplant recipients, there is a clinical observation of an association between multiple seborrhoeic warts and the presence of skin cancer, suggesting that the presence of these warts may serve as a marker for increased skin cancer risk in this population .
Prevention and Vaccination Strategies
Current HPV vaccines target mucosal HPV types and are effective in preventing anogenital cancers and genital warts, but they do not provide protection against beta-HPV types associated with cutaneous warts and skin cancers. There is ongoing research into developing vaccines targeting beta-HPV to help prevent skin tumors, especially in high-risk, immunocompromised individuals, but no such vaccine has been approved for human use yet .
Conclusion
Cutaneous warts themselves are generally benign, but in immunosuppressed individuals, persistent HPV infection and a high burden of warts are linked to a significantly increased risk of skin cancer, particularly squamous cell carcinoma. While most common warts do not progress to malignancy, the presence of multiple or persistent warts in high-risk populations should prompt careful monitoring for skin cancer. Preventive strategies, including the development of vaccines targeting cutaneous HPV types, are an area of active research and may offer future benefits for skin cancer prevention in vulnerable groups 1245+3 MORE.
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