The human papillomaviruses (HPVs) exist as more than 100 distinct types. While variants of HPV are common, only few HPV subtypes have been reported. HPV type 38 has been proposed to be associated with nonmelanoma skin cancer (NMSC), with reported prevalences of up to 55%. A subtype of HPV38 was cloned, completely sequenced and found to have a 96% sequence similarity to prototype HPV38 in the L1 open reading frame. The presence of prototype HPV38 and HPV38b[FA125] was examined in paired biopsies of tape-stripped skin lesions and healthy skin from 269 immunocompetent patients by real-time PCR. Prototype HPV38 and HPV38b[FA125] were present in seven (3%) and five (2%) lesions, respectively, in viral loads ranging from one copy per 150 cells to one copy per 70,000 cells. In summary, we found that HPV38 is heterogeneous and is one of so far only few HPVs that contain subtypes. The heterogeneity needs to be considered in studies of the biology of this virus. ' 2006 Wiley-Liss, Inc.Key words: HPV; subtype; nonmelanoma skin cancer; multiplyprimed rolling circle amplification Nonmelanoma skin cancers (NMSC) are the most prevalent malignancies in the Caucasian population 1 and an increase in prevalence has been seen in European countries during the last few years. 2 NMSC comprises basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC has a relatively good prognosis, while SCC accounts for up to 20% of all deaths from skin cancer. 3 NMSC are often found on sun-exposed sites in patients with the rare inherited genetic disease epidermodysplasia verruciformis (EV). 4 These patients are highly susceptible to human papillomavirus (HPV) infections 5,6 mainly by the Beta-papillomaviruses, a phylogenetic subgroup of cutaneous HPVs (e.g., HPV5 and HPV8). 7 These HPV types are detectable in skin carcinomas, as well as in control specimens of healthy skin from the general population. [8][9][10][11][12] There are more than 100 different HPV types that have been completely sequenced. 7 In addition, there appears to exist about 100 additional putative HPV types, with sequence information so far available only from PCR amplimers. 8,[13][14][15][16] Variants of HPV types contain more than 98% sequence homology in the L1 open reading frame (ORF). 7 Variants is a common finding that appears to associate with ethnic groups and sometimes even with biologic behavior of the virus. 17,18 By contrast, subtypes containing 90-98% sequence homology in the L1 region are very rare, with HPV 68a/HPV68b, HPV46, HPV55 and HPV64 (now known to be subtypes, originally thought to be different viruses) being the only fully characterized examples. 7,17 Although the reasons for this are not known, existence of subtypes has profound implications for design of virus detection systems and for understanding of the biology of the viruses.Epidemiological studies have established a causal association between UV-radiation and NMSC, 3 but the role of HPV in these cancers remains to be elucidated.A recent study 19 has demonstrated that the early proteins E...