Abstract
The prevalence of anal intraepithelial neoplasia has been increasing, especially in
high-risk patients, including men who have sex with men, human immunodeficiency virus
positive patients, and those who are immunosuppressed. Several studies with long-term
follow-up have suggested that rate of progression from high-grade squamous intraepithelial
lesions to invasive anal cancer is ∼ 5%. This number is considerably higher for those
at high risk. Anal cytology has been used to attempt to screen high-risk patients
for disease; however, it has been shown to have very little correlation to actual
histology. Patients with lesions should undergo history and physical exam including
digital rectal exam and standard anoscopy. High-resolution anoscopy can be considered
as well, although it is of questionable time and cost–effectiveness. Nonoperative
treatments include expectant surveillance and topical imiquimod or 5-fluorouracil.
Operative therapies include wide local excision and targeted ablation with electrocautery,
infrared coagulation, or cryotherapy. Recurrence rates remain high regardless of treatment
delivered and surveillance is paramount, although optimal surveillance regimens have
yet to be established.
Keywords
anal intraepithelial neoplasia - human papillomavirus - carcinoma
