ABSTRACT
Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial
lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused
by chronic infection with the human papillomavirus (HPV). The disease is increasing
in both incidence and prevalence, especially among patients with the following risk
factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of
other HPV-related diseases. Although the natural history of the disease is unknown,
there is significant evidence that untreated HSIL progresses to squamous cell carcinoma
in 11% of patients and in up to 50% of patients with extensive disease and immunosuppression.
Anal cytology and reflex HPV DNA testing are used to screen for disease, particularly
among patients with the aforementioned risk factors. Evaluation of the patient should
include physical examination and high-resolution anoscopy (HRA) to evaluate for disease
above and below the dentate line. Intervention is warranted and this can be achieved
in many ways. The treatment option associated with the best outcomes is ablation directed
with HRA, which can be performed in the office or in the operating room with minimal
morbidity. This strategy is effective in patients with both low-volume and high-volume
disease and is associated with a malignant progression rate of 0.4% in patients with
treated HSIL.
KEYWORDS
Anal squamous dysplasia - high-grade squamous intraepithelial lesions - high-resolution
anoscopy
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Carlos E PinedaM.D.
Section of Colon and Rectal Surgery, Stanford University School of Medicine
300 Pasteur Dr., Stanford, CA 94305
eMail: cepineda@stanford.edu
