Outcome after surgical resection for high-grade anal intraepithelial neoplasia (Bowen's disease).
BACKGROUND
High-grade anal intraepithelial neoplasia (Bowen's disease) may predispose to anal carcinoma. Treatment options include surgical resection but effectiveness remains uncertain. This paper reports long-term follow-up of patients with high-grade anal intraepithelial neoplasia treated by surgical resection.


METHODS
Between 1989 and 1996, 46 patients were identified with high-grade anal intraepithelial neoplasia. Thirty-four underwent local excision of all macroscopically abnormal disease and the resulting defect was left open, closed primarily or skin grafted. Regular follow-up subsequently included anoscopy and biopsy of any suspicious lesions.


RESULTS
Median follow-up was 41 (range 12-104) months. Total excision was difficult; 19 patients had histological evidence of incomplete excision at the time of initial resection. Some 12 of 19 had histo-logically proven recurrent high-grade intraepithelial neoplasia within 1 year. Even with microscopically complete excision two of 15 patients subsequently developed recurrent high-grade intraepithelial neoplasia at 6 and 32 months after operation. No patient developed carcinoma but five had complica-tions of anal stenosis or faecal incontinence.


CONCLUSIONS
Although no definite recommendations can be made for the treatment of high-grade anal intraepithelial neoplasia, these results illustrate some potential drawbacks of surgical excision with a high potential for incomplete excision and persistent disease, even after complete excision in some patients, and a high morbidity rate.
Brown
S R
SR
Department of Surgery, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
Skinner
P
P
Tidy
J
J
Smith
J H
JH
Sharp
F
F
Hosie
K B
KB
D001005:Anus Neoplasms / Q000473:pathology / Q000601:surgery*; D001913:Bowen's Disease / Q000473:pathology / Q000601:surgery*; D003663:Decision Trees; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome