This prospective observational study examines if circulating tumor human papillomavirus DNA can be used as an accurate measure of disease status at the time of diagnosis, throughout treatment, and during monitoring in human papillomavirus-associated sinonasal and nasopharyngeal squamous cell carcinomas.

No abstract

Background: Human papillomavirus-associated head and neck squamous cell carcinoma (HPV + HNSCC) occurs in the oropharynx (HPV + OPSCC), sinonasal cavity (HPV + SNSCC), and nasopharynx (HPV + NPC). Circulating tumor HPV DNA (ctHPVDNA) is an accurate tool for diagnosis, treatment monitoring, and recurrence detection. An emerging challenge with ctHPVDNA is that $7.4% of HPV + HNSCC patients develop synchronous or metachronous HPV+ primaries, which could confound ctHPVDNA monitoring.Methods: We describe a 65-year-old patient with T2N1M0 HPV16 + OPSCC and a 55-year-old patient with T2N2M0 HPV16 + OPSCC. Both patients were enrolled in our prospective observational ctHPVDNA study with longitudinal blood collections throughout treatment. Both patients developed multiple HPV+ primaries.Results: Detailed discussion of the patients' treatment courses, the subsequent diagnoses of their second HPV+ primaries, and their ctHPVDNA monitoring is presented.Conclusions: As ctHPVDNA use becomes more prevalent, it is important to recognize that an increase in ctHPVDNA can come not only from the primary tumor or metastatic clones, but also from synchronous or metachronous second primaries.

The auricular composite graft consists of a free tissue graft containing part of the auricular cartilage attached to its overlying skin. The survival of the auricular composite graft depends primarily on its size, and a graft diameter of 1- 2 cm has been previously reported as the critical cut-off size. The auricular composite graft is a reliable option for the reconstruction of skin defects of the nasal sidewall and the nasal ala, and its survival rates can be enhanced with the utilization of specific surgical techniques. These include increasing the contact surface with skin de-epithelization/ perichondrial underlay in the surgical bed, injection of autologous platelet-rich plasma, and non-strangulating nasal sidewall splinting. Here, we report a 64-year-old man with a skin lesion in the right nasal ala who underwent Mohs micrographic surgery. The lesion was reconstructed with the use of composite auricular skin graft.