Role of human papillomaviruses in cutaneous and oral manifestations of immunosuppression

Long-term immunosuppressive drug regimes, used to prevent organ transplant rejection, are associated with an increased risk of epithelial malignancies particularly anogenital and cutaneous cancers. Premalignant and malignant lesions of the oral mucosa have also been reported in renal transplant reci pients (RTRs), particularly of sun-exposed lip lesions. Many of these anoge nital lesions are associated with the detection of high-risk mucosal human papillomaviruses (HPV). Novel degenerate and nested polymerase chain reacti on (PCR) techniques have found high levels of epidermodysplasia verruciform is (EV) HPVs (high-risk cutaneous oncogenic HPVs) in cutaneous warts, dyspl astic keratoses, and squamous cell carcinomas. Unusual appendageal and spin dle cell carcinomas are being observed in RTRs. Increasing survival times o f HIV-positive patients may be associated with dysplasia of orogenital muco sal epithelium, and careful epidemiologic studies of cutaneous lesions are needed. The role of HPVs in the development of these lesions has yet to be established.