Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns” or “Smoke and Mirrors” in the Operating Theatre?

Abstract

IntroductionHuman papillomavirus (HPV) alone is thought to cause ~610,000 cases of cancer per year, and is the dominant aetiological agent for ano-genital (esp. cervical) and head and neck cancers (esp. oropharyngeal). Merkel cell polyomavirus (MCV) is a more recently discovered virus which causes Merkel cell carcinoma, a rare but highly aggressive skin malignancy.MethodsWe explored the available published evidence to see if transmission of live HPV or MCV virus in smoke generated by laser or diathermy was feasible, and would pose an infection risk. Long-term infection with such carcinogenic viruses would then pose an increased risk for the development of virus-induced cancers in medical personnel.ResultsThe morphological structures of both HPV and MCV are very similar, and the size, external capsids and genomic structures show striking similarity. Both viruses have a non-enveloped external protein capsid consisting of 72 capsomeres, and a double-stranded DNA core. Sizes of both viruses range from 50 to 60 nm. There are now recent data demonstrating live and infectious HPV in smoke, and that these viruses can be used to infect cells in vitro. Further, anecdotal reports of virus transmission leading to disease causation in the production of respiratory airway viral warts (benign disease), and, finally, reports of HPV-induced oropharyngeal carcinoma (malignant disease) in two gynaecological surgeons as an occupational health hazard have been published recently.ConclusionThere is now sufficient evidence to support the hypotheses that live infectious carcinogenic viruses can be transmitted via smoke generated from surgical procedures, and, in rare instances, actually cause significant disease. Protective measures such as smoke extraction and airway protection should be instituted for all healthcare personnel, particularly those with multiple repeated exposures such as gynaecological surgeons.

Closed circuit system in laparoscopy: SARS-CoV-2 pandemic

“…Liu et al outlined four articles linking surgical smoke to the transmission of HPV (type 6,11,13), progressing to oropharyngeal squamous cell carcinoma. [9][10][11][12] These cases occurred in otherwise fit healthcare professionals performing gynaecological surgery with no other risk factors for the disease. The HPV genotypes in the infected healthcare professional were identical to those identified in the patient.…”

Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists

“…Another patient was a 62-year-old male gynecologist with a 30 year history of laser ablation and LEEP, having very few other risk factors for oropharyngeal cancer or HPV infection, subsequently developed HPV 16 positive base of tongue cancer 61. Due to that HPV could induce inflammation and carcinoma, protective measures should be instituted for all healthcare personnel, particularly gynecological surgeons 62.…”

Transmission Possibility of COVID-19 via Surgical Smoke Generated by the Use of Laparoscopic Approaches: A Subject of Debate During the Pandemic

“…14 Considering all this, protective measures should be instituted for all health care personnel, particularly for those who are in close contact with surgical plums. 15 Table 1 summarizes studies conducted on evaluating the transmission of HPV via surgical smoke.…”