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Treatment Options for Anal Dysplasia

for Health Care Providers

Treatment Options for Anal Dysplasia

Back to Anal Dysplasia Chapter

Biopsy FindingsTreatment Options
Low-grade lesions (AIN 1)
  • Monitor via HRA every 6 months until normal twice in succession, then annual Pap smear.
  • Topical treatment (see below) may be indicated for symptoms such as bleeding, itching, or burning; or for discrete lesions.
High-grade lesions (AIN 2 or 3)Topical therapy
For small lesions (<1 cm2 at the base):
  • Local application of bichloroacetic acid or 80-90% trichloroacetic acid (well-tolerated but occasionally painful)
  • Liquid nitrogen
Other topical, self-applied options studied in small cohorts include:
  • Topical imiquimod applied for 6-10 hours then washed off, TIW for 16 weeks
  • Topical 5% 5-fluorouracil applied BID for 16 weeks
  • These sometimes are used to treat diffuse lesions
Infrared coagulation (office based)
  • For lesions too large for topical therapy
  • Followed by debridement of destroyed tissue using biopsy forceps
  • Note: this treatment is not yet FDA approved
Surgery and CO2 laser ablation
  • For large (>1 cm2) or extensive lesions, or for patients unable to receive infrared coagulation
  • Surgical excision with a scalpel for discrete lesions with or without laser ablation
  • Large lesions may require multiple, staged procedures to reduce risk of bleeding, anal stenosis, sphincter compromise, and infection
  • Referrals should be made to surgical centers with experience in treating anal dysplasia
Follow-up HRA should be done every 6 months
SCCAFull discussion of anal cancer is beyond the scope of this chapter, but special points are noted below:
  • Clinical staging consists of physical examination and biopsy of the primary tumor, palpation of the groin, CT of the chest, and CT or MRI of the abdomen and pelvis
  • Staging is based on size of tumor (T1-4) and node positivity (N0-3 for nodal metastases) and correlates with 5-year survival rate
  • First-line treatment consists of chemoradiotherapy rather than surgery

From Anal Dysplasia
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009