Dysplasia of the Anus

Clinical

Patients at high risk of developing dysplasia or carcinoma include those with:
- Immunosuppression
  - HIV seropositivity and low CD4 counts
  - Solid organ allografts
- History of lower genital tract neoplasia
- Persistent high-risk HPV genotype infection or infection with multiple HPV genotypes
- Heavy cigarette smoking
- Frequent anoreceptive intercourse
- Radiation
HSIL is generally treated by local excision
- Frequently recurs (30% in 5 years)
- We consider HSIL or the presence of high risk HPV to be an indication for high resolution mapping and targeted ablation or resection
- We consider LSIL in high risk patients to justify topical therapy with surveillance