Nichols Anna J, Allen Amber Heyna, Shareef Shahjahan, Badiavas Evangelos V, Kirsner Robert S, Ioannides Tim
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
St Petersburg General Hospital, St Petersburg, Florida.
JAMA Dermatol. 2017 Jun 1;153(6):571-574. doi: 10.1001/jamadermatol.2016.5703.
Keratinocyte carcinomas (KCs), consisting of squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs), are the most common human malignant neoplasms. Several risk factors have been implicated in KC development. For some SCCs, particularly those in immunocompromised patients, human papillomavirus (HPV) may be an important factor.
To determine whether quadrivalent HPV vaccination would affect the development of KCs in immunocompetent patients with a history of multiple KCs.
DESIGN, SETTING, AND PARTICIPANTS: Two patients with a history of multiple KCs-a man in his 70s (patient 1) and a woman in her 80s (patient 2)-were treated in a private dermatology practice. Each patient received 3 doses of the quadrivalent HPV vaccine at 0, 2, and 6 months in 2013, and both patients underwent full-body skin examinations at least every 3 months. Biopsy-proven skin cancers were recorded for 16 months (for patient 1) or 13 months (for patient 2) after the first dose of vaccine and then compared with the number of biopsy-proven skin cancers recorded over a similar period before the first dose of vaccine. The period of observation was from October 18, 2011, to June 21, 2014.
The numbers of new SCCs and BCCs after the first dose of the quadrivalent HPV vaccine.
Patient 1 had a mean of 12 new SCCs and 2.25 new BCCs per year before vaccination. After vaccination, he developed 4.44 SCCs and 0 BCCs per year, a 62.5% reduction in SCCs and a 100% reduction in BCCs. Patient 2 had a mean of 5.5 new SCCs and 0.92 new BCCs per year before vaccination. After vaccination, she developed 1.84 SCCs and 0 BCCs per year, a 66.5% reduction in SCCs and a 100% reduction in BCCs. The quadrivalent HPV vaccine was well tolerated by both patients and had no adverse effects.
A reduction of SCCs and BCCs was observed in 2 patients after administration of the quadrivalent HPV vaccine. These findings highlight the possibility that cutaneous SCC development, and perhaps BCC development, may be driven in part by HPV in immunocompetent patients. Human papillomavirus vaccination may represent an efficacious, cost-effective, readily available, and well-tolerated strategy for preventing KCs.
角质形成细胞癌（KCs）包括鳞状细胞癌（SCCs）和基底细胞癌（BCCs），是人类最常见的恶性肿瘤。几种风险因素与KC的发生有关。对于某些SCCs，特别是免疫功能低下患者的SCCs，人乳头瘤病毒（HPV）可能是一个重要因素。
确定四价HPV疫苗接种是否会影响有多个KC病史的免疫功能正常患者KC的发生。
设计、地点和参与者：两名有多个KC病史的患者——一名70多岁的男性（患者1）和一名80多岁的女性（患者2）——在一家私立皮肤科诊所接受治疗。每位患者于2013年在0、2和6个月时接种3剂四价HPV疫苗，两名患者均至少每3个月进行一次全身皮肤检查。在接种第一剂疫苗后的16个月（患者1）或13个月（患者2）记录经活检证实的皮肤癌，然后与接种第一剂疫苗前相似时间段内记录的经活检证实的皮肤癌数量进行比较。观察期为2011年10月18日至2014年6月21日。
接种第一剂四价HPV疫苗后新的SCCs和BCCs数量。
患者1接种疫苗前每年平均有12个新的SCCs和2.25个新的BCCs。接种疫苗后，他每年发生4.44个SCCs和0个BCCs，SCCs减少62.5%，BCCs减少100%。患者2接种疫苗前每年平均有5.5个新的SCCs和0.92个新的BCCs。接种疫苗后，她每年发生1.84个SCCs和0个BCCs，SCCs减少66.5%，BCCs减少100%。两名患者对四价HPV疫苗耐受性良好，且无不良反应。
两名患者接种四价HPV疫苗后SCCs和BCCs数量减少。这些发现突出了在免疫功能正常的患者中，皮肤SCC发生，可能还有BCC发生，可能部分由HPV驱动的可能性。人乳头瘤病毒疫苗接种可能是预防KCs的一种有效、经济高效、易于获得且耐受性良好的策略。
