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Reconstructive Surgery of the Rectum, Anus and Perineum pp 191–199Cite as

Medical Management of Anal Intraepithelial Neoplasia

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Abstract

Although anal cancer is a rare disease in the general population, its incidence is growing in both men and women by about 2 % per year. However, the incidence is substantially higher among certain populations, most notably men who have sex with men and immunosuppressed individuals, including those with human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN; anal intraepithelial neoplasia [AIN] grades 2/3) is the precursor of anal cancer, and treatment of HGAIN has the potential to reduce the overall incidence of anal cancer. This is an emerging area, with efforts being made in many locations to establish screening programs targeted to at-risk individuals, followed by high-­resolution anoscopy and biopsy to establish the grade of AIN and to exclude anal cancer. The proctologist, general surgeon, and colorectal surgeon are key members of the AIN management team. Initial treatment for HGAIN should be mostly office-based and may be performed by surgeons or nonsurgeons. However, surgeons play a key role by performing operating theater–based procedures, including examination under anesthesia of lesions too large to be adequately assessed in the office and wide local excision or ablation of lesions not amenable to office-based procedures. Surgical back-up also is necessary to handle complications of office-based procedures, such as bleeding or abscess formation.

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Authors and Affiliations

  1. Department of Infectious Diseases, University of California, 513 Parnassus Ave, Room S420, 0654, San Francisco, CA, 94143, USA

    Joel Palefsky M.D., FRCP(C)

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  1. Joel Palefsky M.D., FRCP(C)
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Correspondence to Joel Palefsky M.D., FRCP(C) .

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Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

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Palefsky, J. (2013). Medical Management of Anal Intraepithelial Neoplasia. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_17

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  • DOI: https://doi.org/10.1007/978-1-84882-413-3_17

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  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

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