Abstract
A 53 year-old male gynecologist presented with human papillomavirus (HPV) 16 positive tonsillar squamous cell carcinoma. He had no identifiable risk factors with the exception of long term occupational exposure to laser plumes, having performed laser ablations and loop electrosurgical excision procedures (LEEP) on greater than 3000 dysplastic cervical and vulvar lesions over 20 years of practice. The second patient is a 62 year old male gynecologist with a 30 year history of laser ablation and LEEP who subsequently developed HPV 16 positive base of tongue cancer. He also had very few other risk factors for oropharyngeal cancer or HPV infection. HPV is a probable causative agent for oropharyngeal squamous cell carcinoma and has been reported as being transmittable through laser plume. This paper suggests that HPV transmitted through laser plume can result in subsequent squamous cell carcinoma.
Highlights
Carbon dioxide (CO2) lasers are commonly used to excise lesions on the larynx, cervix, lower genital tract, and perianal regions
This article reports on a case of human papillomavirus (HPV)-16 positive oropharyngeal squamous cell carcinoma in two laser surgeons following occupational exposures to laser plumes
There is a strong body of evidence supporting a causal relationship between oncogenic HPV types and head and neck squamous cell carcinomas
Summary
Carbon dioxide (CO2) lasers are commonly used to excise lesions on the larynx, cervix, lower genital tract, and perianal regions. Certain HPV subtypes are known to be oncogenic, laser plume exposure may put health care professionals at increased risk of oropharyngeal carcinoma development This case report describes, to our knowledge, the first cases of HPV-16 positive oropharyngeal squamous cell carcinomas in two surgeons following long-term occupational laser plume exposure. Patient A had no identifiable risk factors for oropharyngeal cancer or HPV with the exception of occupational exposure to HPV-positive laser plumes, having performed laser ablation and later loop electrosurgical excision procedures (LEEP) of more than 3000 dysplastic cervical and vulvar lesions over 20 years. Most of these procedures were performed in an environment without proper ventilation or mask. This patient may have contracted HPV through occupational laser plume exposure
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