title: Role of human papillomavirus in cutaneous squamous cell carcinoma: a meta-analysis.
abstract: BACKGROUND
  The role of human papillomavirus (HPV) in cutaneous squamous cell carcinoma (cuSCC) is not well defined, with past studies showing conflicting results.
  
  
  OBJECTIVE
  We sought to determine if there is a significant association between HPV and cuSCC and whether cuSCC from immunosuppressed patients are more likely to carry HPV than cuSCC from immunocompetent patients.
  
  
  METHODS
  We performed a systematic review and abstracted data from articles that included: skin samples by biopsy, HPV detection by polymerase chain reaction, and a minimum of 10 cases and 10 controls. Pooled effect size and 95% confidence intervals were calculated using random effects meta-analysis using the inverse variance method.
  
  
  RESULTS
  cuSCC were more likely to carry HPV than normal-appearing skin (pooled effect size [ES] 3.43, 95% confidence interval 1.97-5.98, P < .0001) in all patients. An increase in HPV prevalence was found in tumors from immunosuppressed patients compared with immunocompetent patients (pooled ES 3.01, 95% confidence interval 2.00-4.52, P < .0001).
  
  
  CONCLUSIONS
  The greatest limitation is the heterogeneity of the studies included. The association of higher HPV prevalence in squamous cell carcinoma compared with normal-appearing skin does not imply causality.
  
  
  CONCLUSIONS
  These results contribute to evidence that HPV is associated with cuSCC. Higher HPV burden in tumors from immunosuppressed patients compared with immunocompetent patients may have therapeutic implications.
authors.affiliation: Department of Dermatology, New York Medical College, Valhalla, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Bishr
authors.initials: B
authors.lastname: Aldabagh
authors.affiliation: Department of Dermatology, St Louis University, St Louis, Missouri.
authors.forename: Justin
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Dermatology, University of California, San Francisco, California. Electronic address: ArronS@derm.ucsf.edu.
authors.forename: Sarah Tuttleton
authors.initials: ST
authors.lastname: Arron
mesh_terms: D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology / Q000821:virology*; D016022:Case-Control Studies; D015897:Comorbidity; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology / Q000821:virology*; D019562:Viral Load / Q000276:immunology
keywords: cutaneous squamous cell carcinoma; human papillomavirus; immunocompetence; immunosuppression; meta-analysis; skin cancer