Expectant management of anal squamous dysplasia in patients with HIV.
OBJECTIVE
Anal squamous dysplasia is commonly found in patients with HIV infection. There is no satisfactory treatment that eradicates this premalignant lesion with low morbidity and low recurrence. This study reviews a series of patients with HIV and an abnormal anal examination who had squamous dysplasia and who have been followed with physical examination alone and with repeat biopsies as necessary for new or suspicious lesions.


METHODS
We reviewed the charts of 40 HIV-positive men who had squamous dysplasia of the anal canal and anal margin, focusing on history, physical findings, histologic diagnosis, and the occurrence of invasive squamous-cell carcinoma.


RESULTS
Forty HIV-positive men (mean age, 39 years) were followed for anal squamous dysplasia. Biopsies revealed dysplasia, which was usually multifocal. The grade of dysplasia varied, but 28 of 40 patients had at least one area of severe dysplasia. All patients had a follow-up period greater than one year (mean, 32 months; range, 13-130 months). Three patients developed invasive carcinoma while under surveillance, and these were completely excised or cured with chemoradiation.


CONCLUSIONS
Extensive excision for dysplasia in the context of HIV confers high morbidity and questionable benefit, and other treatments are of uncertain value. In a group of patients followed expectantly, most did not develop invasive cancer, and in those who did, early cancers could be identified and cured. Physical examination surveillance for invasive carcinoma may be acceptable for following patients with HIV and biopsy-proven squamous dysplasia.
Devaraj
Bikash
B
Surgical Service (112E), VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, California 92161-0002, USA.
Cosman
Bard C
BC
D000328:Adult; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D003657:Decision Making; D018450:Disease Progression; D005500:Follow-Up Studies; D006678:HIV / Q000276:immunology*; D015483:HIV Antibodies / Q000276:immunology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
D015483:HIV Antibodies