Ablative therapies for the treatment of anal high-grade squamous intraepithelial lesions

Anal HSIL is the precursor lesion of anal squamous cell carcinoma. The exact rate of cancer progression from HSIL is not clear, but likely approaches 10% in immunocompromised individuals. Just as excision and destruction of cervical dysplasia has been shown to significantly decrease the risk of cervical cancer, several studies have shown a reduced incidence of anal cancer after targeted ablation of HSIL. Given the morbidity of anal mapping and wide local excision, we cannot justify this treatment method, especially since recurrence is common. Except for the most severe cases, anal and perianal lesions are very amenable to office-based treatments. Topical therapies have a role in treating anal and perianal HSIL, especially in the setting of wide-spread disease. However, ablation has been shown to be more effective and better tolerated compared to topical treatments. Recurrence is to be expected following treatment of HSIL, highlighting the need for close long-term follow-up.