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Anal squamous intraepithelial lesions: an update and proposed management algorithm.

T Chittleborough1, R Tapper2, T Eglinton2,3

  • 1Department of General Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, 8140, New Zealand. timothy@chittleborough.com.au.

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|December 14, 2019
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Summary

Anal squamous intraepithelial lesions (ASIL) are premalignant changes preceding anal cancer, driven by HPV. Early detection and treatment of high-grade ASIL are crucial for preventing invasive cancer and maintaining continence.

Keywords:
Anal intraepithelial neoplasiaAnal squamous cell carcinomaAnal squamous intraepithelial lesionHuman papilloma virus

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Area of Science:

  • Oncology
  • Virology
  • Dermatology

Background:

  • Anal squamous intraepithelial lesions (ASIL) represent premalignant changes in anal squamous cells.
  • These lesions are primarily caused by the human papilloma virus (HPV), a known carcinogen.
  • High-grade ASIL have a significant progression rate to invasive squamous cell carcinoma, estimated at 12% within 5 years.

Purpose of the Study:

  • To review current evidence regarding anal squamous intraepithelial lesions (ASIL).
  • To propose a management algorithm for ASIL.
  • To guide clinicians in preventing progression to anal cancer.

Main Methods:

  • Systematic review of contemporary evidence on ASIL.
  • Analysis of progression and regression patterns of ASIL.
  • Evaluation of current management strategies for ASIL.

Main Results:

  • HPV is the primary driver of ASIL pathophysiology.
  • ASIL management involves identifying and treating high-grade lesions.
  • Effective management strategies include surveillance, excision, ablative, and topical therapies.

Conclusions:

  • Management of ASIL aims to prevent progression to invasive cancer and preserve fecal continence.
  • HPV vaccination is a key strategy for primary prevention of ASIL.
  • A structured management algorithm is essential for optimal patient outcomes.