Stuart Winter

Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma

Despite a reduction in smoking and alcohol consumption, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising. This is attributed to human papilloma virus (HPV) infection and screening for HPV is now recommended in all cases of OPSCC. Despite a variety of clinically available tests and new non-invasive test strategies there is no consensus on which technique is best. This review reports on current techniques for HPV detection in OPSCC and the clinical applicability of emerging techniques. Literature searches of Medline, Embase and clinicaltrials.gov using the search terms ‘head and neck neoplasms’, ‘squamous cell carcinoma’ and ‘HPV testing’ were performed. 45 studies were identified and included. p16 immunohistochemistry (IHC), HPV DNA in situ hybridization (ISH) and HPV polymerase chain reaction (PCR) are the commonest tests to determine HPV status. p16 IHC and HPV DNA PCR are highly sensitive whilst HPV DNA ISH is more specific, these techniques conventionally utilize surgical biopsies. New tests using PCR to screen fine needle aspirates, saliva, brush cytology and serum for HPV are promising but have variable sensitivity and specificity. These non-invasive samples avoid the morbidity of surgical biopsies and need for tissue blocks; their clinical role in screening and surveillance remains largely untested. Further work is needed to validate these tests and define their role.

Mucosal melanoma of the upper airways tract mucosal melanoma: A systematic review with meta-analyses of treatment

Mucosal melanoma of the upper aerodigestive tract (MM‐UADT) occurs in a complex anatomic region. It represents a small number of tumors of the head and neck and a small number of melanoma cases.

Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience

The diagnosis of cancer of unknown primary (CUP) in head and neck occurs when the treating clinicians have utilised all available diagnostic tests and failed to identify the origin of the disease. There is no agreed consensus on which diagnostic investigations to use, or the order in which to use them in, although broad recommendations exist. Small tumours arising in the tongue base can be below the limits of resolution of conventional diagnostic techniques. Given the difficulty in targeting the tongue base, current practice involves blind random biopsies, which leads to a variable detection rate. Robotically assisted surgical removal of the tongue base, tongue base mucosectomy (TBM) has been shown to improve diagnostic yield. This study reports the diagnostic hit rate for tongue base primaries using this technique.

Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK?

To identify the most cost‐effective treatment strategy in patients with early stage (T1 and T2) cancers of the laryngeal glottis.

Use of the self‐retaining Alexis ring retractor in transoral robotic surgery

Ring retractors, such as the Alexis® wound retractor, are simple devices used in a wide range of surgical settings to provide atraumatic exposure while protecting wound edges.

Letter to editor: Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma

1. Qureishi A, Mawby T, Fraser L, Shah KA, Moller H, Winter S (2017) Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-017-4503-1 2. Kim SM KI, Myoung H, Lee JH, Lee SK (2017) Human papillomavirus (HPV) in Korean oral cancer patients using microarray technology. Human Pathol (submitted) 3. Lim YK, Choi JH, Park S, Kweon OJ, Park AJ (2016) Comparison of three different commercial kits for the human papilloma virus genotyping. J Clin Lab Anal 30(6):1110–1115. doi:10.1002/jcla.21989 Dear Editor,

Saliva testing for human papilloma virus in oropharyngeal squamous cell carcinoma: A diagnostic accuracy study.

New cases of oropharyngeal squamous cell carcinoma (OPSCC) are routinely tested for HPV. HPV in saliva can be detected with PCR, but its clinical applicability in the context of OPSCC remains unknown.

Upper aerodigestive tract cancer: summary of the National Institute for Health and Care Excellence guidelines for England and Wales.

Health and Care Excellence guidelines for England and Wales Paleri, V.,* Kerawala, C., Winter, S., Robinson, M., Jarrom, D., Prettyjohns, M. & On behalf of the NICE Upper Aerodigestive Tract Cancer Guidelines Committee *Newcastle upon TyneHospitals, Newcastle upon Tyne, RoyalMarsdenHospital, London, OxfordUniversity Hospitals, Oxford, Cancer Research Centre, Weston Park Hospital, Sheffield, National Collaborating Centre for Cancer, Cardiff, UK

Nodular fasciitis of soft tissue over the mandible

Nodular fasciitis (NF) is an unusual, benign condition which can mimic more sinister, sarcomatous lesions both clinically and histologically. This case report presents a 35-year-old male, with a rapidly growing mass on the border of his left mandible, referred to a specialist head and neck unit. The initial presentation, radiology and cytology were initially inconclusive and the possibility of a malignant process was considered. Final histology was that of NF, the treatment of which is complete surgical excision. Therefore, NF is an important differential to consider when assessing similar clinical presentations, as highlighted in this case report.