Objectives
Although causal associations between oral leukoplakia (OL), oral squamous cell carcinoma (OSCC) and high‐risk human papillomavirus (HR‐HPV) have been speculated upon in several reports, conclusive evidence has not been presented. This study investigates whether the number of cases of HR‐HPV in OL has increased over time and whether the prevalence of HR‐HPV‐positive OL differs in various parts of the world.
Patients and Methods
A total of 432 patients with OL from Sweden, Brazil and Romania were analysed. Patients were divided into historical (1992–2002) and contemporary (2011–2017) cohorts from the respective countries. Seventeen patients with OL developed oral squamous cell carcinoma (OSCC). A real‐time PCR assay, targeting HPV sub‐types 6,11,16,18,31,33,35,39,45,52,56,58 and 59, was performed to detect HR‐HPV in patients with OL.
Results
In the Swedish and Romanian cohorts, none of the investigated HPV sub‐types were detected. In the Brazilian cohorts, five patients with OL (3%) were positive for HR‐HPV, including four patients from the contemporary cohort (HPV 16, 31, 33) and one from the historical cohort (HPV 11). All the cases of OL that transformed into OSCC were HR‐HPV‐negative, as were the corresponding tumours.
Conclusions
In summary, the prevalence of HR‐HPV in OL is low in all the tested countries, and the incidence has not changed over time. HR‐HPV in OL does not seem to be a driver of oncogenesis.
HPV clinical manifestations have their characteristics modified by the use of combined antiretroviral therapy (cART), although its incidence is unaffected by cART. We report an unusual presentation of oral HPV infection and discuss an effective treatment for disseminated HPV lesions. A 52-year-old male of Asian-origin, HIV-seropositive, presented with extensive nodular lesions throughout the oral mucosa extending to the oropharyngeal region. Biopsy followed by histopathological examination and HPV genotyping were performed. The treatment was initiated with topical application of podophyllin and trichloroacetic acid. HPV lesions in oral mucosa are generally easy to handle. Extensive lesions can make it difficult to choose an effective treatment that meets the patient’s particularities and medication availability.
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