Background This review addresses current issues regarding epidermodysplasia verruciformis (EV), which are relevant in clinical practice and to comprehend the mechanisms by which human papillomavirus (HPV) acts in cutaneous carcinogenesis. Main body EV is an unusual genodermatosis, related to beta-HPV, with high risk for developing skin cancer. Clinical manifestations begin in childhood and they are characterized by flat warts, pityriasis versicolor-like macules and seborrheic keratoses lesions. Up to 50% of EV patients develop nonmelanoma skin cancer in sun exposed areas, mainly squamous cell carcinomas (SCC). Unlike genital carcinomas associated to alpha-HPV, in which transcriptionally active viral genomes invariably occurs, the EV-HPV seems to act by interaction with the host cell, the ultraviolet radiation and immunosuppression to result in carcinogenesis. The EV diagnosis is clinical and it can be confirmed by characteristic histopathological findings and EV-HPV identification. Until now, there is no effective treatment for EV. EV patients need regular clinical follow-up for early detection and treatment of cutaneous carcinomas. Conclusion Despite the rarity of EV, the study of this genodermatosis is important to better understand the process of beta-HPV carcinogenesis.

BackgroundPost-kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis (VL), which may occur after or during treatment. It has been frequently reported from India and the Sudan, but its occurrence in South America has been rarely reported. It may mimic leprosy and its differentiation may be difficult, since both diseases may show hypo-pigmented macular lesions as clinical presentation and neural involvement in histopathological investigations. The co-infection of leprosy and VL has been reported in countries where both diseases are endemic. The authors report a co-infection case of leprosy and VL, which evolved into PKDL and discuss the clinical and the pathological aspects in the patient and review the literature on this disease.Case presentationWe report an unusual case of a 53-year-old female patient from Alagoas, Brazil. She presented with leprosy and a necrotizing erythema nodosum, a type II leprosy reaction, about 3 month after finishing the treatment (MDT-MB) for leprosy. She was hospitalized and VL was diagnosed at that time and she was successfully treated with liposomal amphotericin B. After 6 months, she developed a few hypo-pigmented papules on her forehead. A granulomatous inflammatory infiltrate throughout the dermis was observed at histopathological examination of the skin biopsy. It consisted of epithelioid histiocytes, lymphocytes and plasma cells with the presence of amastigotes of Leishmania in macrophages (Leishman’s bodies). The diagnosis of post-kala-azar dermal leishmaniasis was established because at this time there was no hepatosplenomegaly and the bone marrow did not show Leishmania parasites thus excluding VL. About 2 years after the treatment of PKDL with liposomal amphotericin B the patient is still without PKDL lesions.ConclusionPost-kala-azar dermal leishmaniasis is a rare dermal complication of VL that mimics leprosy and should be considered particularly in countries where both diseases are endemic. A co-infection must be seriously considered, especially in patients who are non-responsive to treatment or develop persistent leprosy reactions as those encountered in the patient reported here.

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Radiotherapy might be associated with progression of SCC in patients with EV, and it is recommended that radiotherapy should be avoided in this patient population.

The oncogenic role of high-risk HPV in anogenital, head and neck, and cervical cancer is well recognized, but not in skin cancer in the general population. Some authors have demonstrated their appearance mainly on the hands and feet, particularly in the area of the nail bed, which could be due to contamination with HPV types from anogenital regions. Here, we describe a case of genital HPV associated with SCC on the nose tip in an immunocompetent young man, which was confirmed by histopathological findings and in situ hybridization. The importance of this report is to highlight the potential role of HPV in the etiology of skin cancer in an immunocompetent individual.