Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients.

OBJECTIVE To describe a treatment and follow-up protocol for HIV patients with anal dysplasia or warts, which are at risk of malignant change. DESIGN An ongoing study of highly selected patients referred to a single surgeon. SETTING The Colorectal and HIV/AIDS Clinics, University of Ottawa, General Campus. PATIENTS Ninteen young men who presented with suspicious anal lesions and were referred to the Colorectal Clinic by the HIV/AIDS Clinic, which sees approximately 800 patients per year. OUTCOME MEASURE Significance of dysplasia or carcinoma. RESULTS Of the 19 patients, 14 had dysplasia, carcinoma-in-situ or invasive carcinoma. All were treated with multiple mapped cold biopsies and local or wide excision as indicated. Two patients with invasive carcinoma received radiotherapy or chemotherapy, or both. CONCLUSIONS The incidence of dysplasia or the sequence by which dysplasia progresses to invasive carcinoma is unknown. Surveillance of HIV patients, especially those with nodules or warts, by flexible sigmoidoscopy and Papanicolaou smears every 3 to 12 months is recommended, depending on the severity of the anal lesion.