Absence of latent Epstein-Barr virus in cutaneous squamoproliferative lesions after solid organ transplantation

Recent studies implicate Epstein-Barr virus (EBV) in the pathogenesis of an increasing number of lymphoid and epithelial tumors. EBV-related disorders are particularly prevalent in immunosuppressed patients. The most common neoplasms arising in persons receiving long-term immunosuppressive agents after organ transplantation include non-Hodgkin's lymphomas and skin and lip carcinomas. Because EBV plays a major role in the evolution of post-transplantation lymphoproliferative disorders and was recently identified in a squamous cell carcinoma of the lip in a renal transplant recipient, we examined squamoproliferative lesions of the skin and lips for the presence of latent EBV. Twenty-six paraffin-embedded specimens from 23 different squamoproliferative lesions occurring in 9 solid organ transplant recipients were examined for the presence of latent EBV by in situ hybridization for EBV-encoded small RNA (EBER-1). The squamoproliferative lesions included 16 squamous cell carcinomas, 3 re-excisions of squamous cell carcinomas, 5 basal cell carcinomas, and 2 actinic keratoses. Two lesions from a single patient exhibited clusters of positive dermal lymphocytes after in situ hybridization with the EBER-1 probe. This patient is currently without clinical evidence of a lymphoproliferative disorder 2 years after the first biopsy showing this phenomenon. The squamoproliferative lesions were all uniformly negative. EBV does not seem to play a role in the initiation or progression of the majority of cutaneous squamoproliferative lesions arising in immunosuppressed patients who received solid organ transplants.