title: Surgical excision alone for stage T1 anal verge cancers in people living with HIV.
abstract: Anal cancer accounts for a small percentage of colorectal malignancies. Early stage (T1N0M0) cancers of the anal verge have been treated with local surgical excision alone in individuals without human immunodeficiency virus (HIV) infection. The risk of anal cancer is higher in people living with HIV (PLWH). We present results of the outcomes of T1 anal verge cancers treated by local excision only in a series of PLWH.
  
  
  
  Demographic and clinicopathological data was prospectively collected from all HIV positive individuals with anal cancer, treated between 1986 and 2015. The date from anal cancer diagnosis until the date of the last follow up were collected.
  
  
  
  Fifteen patients had T1N0M0 cancer of the anal verge from a total of 92 patients with HIV-associated anal cancer. The mean age was 49 years (range 36-57). The average age of HIV diagnosis was 35 years (range 19-48) and four patients had a diagnosis of AIDS prior to the diagnosis of anal cancer. All patients were surgically managed with complete local excision of the tumour. There were no complications or need for any adjuvant therapy. No patients have relapsed and at a median follow up of 4 years (range 3-15), the overall survival was 100%.
  
  
  
  Surgical resection for early stage anal verge cancers is an effective strategy in PLWH. Increasing awareness of anal cancer and anoscopy surveillance in PLWH will hopefully continue to identify anal cancers at an early stage that are amenable to minimally invasive surgical management.
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK. Electronic address: m.alfa-wali@imperial.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Alfa-Wali
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dalla Pria
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nelson
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Tekkis
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Bower
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: AIDS; Anal cancer; Anal verge cancers; HIV; Local excision