HPV Vaccination in Immunosuppressed Patients with Established Skin Warts and Non-Melanoma Skin Cancer: A Single-Institutional Cohort Study

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.

Update on Squamous Cell Carcinoma of the Nail Unit: An Human Papillomavirus-Associated Condition

“…The proximal nail matrix expresses lower levels of HLA-A/B/C, has fewer CD4+ and CD8+ T cells, and the antigen-presenting capacity of Table 1. Risk stratification of HPV type High-risk 16,18,31,33,35,39,45,51,52,56,58,59,66,11,40,42,43,44,54,61,72,81,89 Classification by carcinogenic risk of alpha HPVs [9]. Bold indicates inclusion in Gardasil-9® vaccine.…”

“…Intramuscular injection with Gardasil-9 has also been shown to reduce the actinic keratosis burden in immunocompetent patients with significant actinic damage [55]. A retrospective study of immunocompromised patients with a history of cutaneous SCC and viral warts evaluated the number of dermatological procedures occurring pre-and postvaccination with Gardasil-9 [56]. Bossart et al [56] identified a reduction in the number of dermatologic interventions following vaccination with Gardsil-9.…”

“…A retrospective study of immunocompromised patients with a history of cutaneous SCC and viral warts evaluated the number of dermatological procedures occurring pre-and postvaccination with Gardasil-9 [56]. Bossart et al [56] identified a reduction in the number of dermatologic interventions following vaccination with Gardsil-9. One case of nail unit SCC treated with HPV vaccination has been reported.…”