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Vulvar Seborrheic Keratosis: Is There a Relationship to Human Papillomavirus?

Reutter, Jason C. MD1; Geisinger, Kim R. MD1,2; Laudadio, Jennifer MD3

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 190–194
doi: 10.1097/LGT.0b013e3182952357
Basic Science

Objective We sought to determine the prevalence of human papillomavirus (HPV) subtypes in vulvar seborrheic keratoses (SK) by polymerase chain reaction (PCR) in women with a theoretically low risk of recent HPV transmission. We also attempted to identify which histopathologic features best correlated with HPV and specific subtypes.

Methods Twenty-eight cases of vulvar SK in women older than 50 years old were retrospectively pulled from our files from a 7-year period. Cases were histologically examined for the presence of 7 features: parakeratosis, horn cysts, pigmentation, “clonal” cells, papillomatosis, “whorls,” and reticulation of rete. For controls, PCR was performed on all cases for HPV detection and typing. Ten cutaneous SK and 7 vulvar condyloma acuminata were also evaluated for HPV by PCR.

Results Twenty-one vulvar SK had sufficient genetic material for HPV PCR analysis. Only 3 (14.29%) were positive for HPV, 2 were type 6, and 1 was an unknown type. All cutaneous SK were negative and all condyloma acuminatum were positive for HPV. There was no histologic feature that separated HPV-positive from HPV-negative vulvar SK, although there was a tendency for parakeratosis to be associated with HPV positivity.

Conclusions The rate of HPV positivity in vulvar SK in women older than 50 years is much lower than expected and not statistically significantly associated with specific histologic features. One explanation may be that vulvar SK have diminishing levels of HPV genetic material in the relatively older ages of the patients in our study. Alternatively, vulvar SK may have no relationship to HPV, and strict histologic criteria may separate vulvar SK from condyloma acuminatum. In this instance, the few cases of HPV-positive vulvar SK may reflect incidental persistence of HPV in vulvar epidermis. Furthermore, these possibilities may vary among different populations, for example, based on patient age.

This study determined that 14% of vulvar serborrheic keratoses in women older than 50 years contain HPV DNA by polymerase chain reaction.

1Piedmont Pathology Associates, Hickory, NC; 2Department of Pathology and Laboratory Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC; and 3Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR

Reprint requests to: Jason C. Reutter MD, Piedmont Pathology Associates, 1899 Tate Blvd SE, Hickory, NC 28601. E-mail:

The authors received financial support from the Department of Pathology, Wake Forest University.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology