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

Megill, Christina; Wilkin, Timothy

doi:10.1053/j.scrs.2017.04.006

Cited by 17 publications

(10 citation statements)

References 49 publications

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“…It can be applied during examination, and is well-tolerated. Retrospective studies show that TCA can induce clearance of high-grade AIN in 71-79% of patients, but may not be effective for extensive or bulky disease [51]. 5-FU is a chemotherapy agent that inhibits DNA synthesis and, when applied topically, can clear AIN.…”

Section: Treatmentmentioning

confidence: 99%

Anal intraepithelial neoplasia: diagnosis, screening, and treatment

Siddharthan

Lanciault

Tsikitis

2019

aog

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Anal intraepithelial neoplasia (AIN) is a premalignant lesion for anal cancer. It is more commonly found in high-risk patients (e.g., human papilloma virus (HPV)/human immunodeficiency virus infections, post-organ transplantation patients, and men who have sex with men) and development is driven by HPV infection. The incidence of AIN is difficult to estimate, but is heavily skewed by preexisting conditions, particularly in high-risk populations. The diagnosis is made from cytology or biopsy during routine examinations, and can be performed at a primary care provider’s office. A pathologist can then review and classify cells, based on nucleus-to-cytoplasm ratios. The classification of low or high grade can better predict progression from AIN to anal cancer. There is little debate that AIN can develop into anal cancer, and the main rationale for treatment is to delay the progression. Significant controversy remains regarding screening, surveillance, and treatment for AIN. Management options are separated into surveillance (watchful waiting) and interventional strategies. Emerging data suggest that close patient follow up with a combination of ablative and topical treatments may offer the greatest benefit. HPV vaccination offers a unique treatment prior to HPV infection and the subsequent development of AIN, but its use after the development of AIN is limited. Ablative treatment includes excision, fulguration, and laser therapy.

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Section: Treatmentmentioning

confidence: 99%

Anal intraepithelial neoplasia: diagnosis, screening, and treatment

Siddharthan

Lanciault

Tsikitis

2019

aog

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“…[4][5][6] Given the potential drawbacks associated with surgical excision of these lesions such as pain, bleeding and anal stenosis, 7 alternative, more conservative therapeutic methods have been used. [8][9][10] Nevertheless, to date, no therapeutic strategy for anal HSIL has demonstrated long-term control of these lesions, with issues being moderate efficacy and high recurrence rates probably related to the multifocal nature of this pathology.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness and tolerability of imiquimod suppositories to treat extensive intra-anal high-grade squamous intraepithelial lesions/warts in HIV-infected individuals

et al. 2019

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Topical imiquimod is a potential treatment for intra-anal condyloma and squamous intraepithelial lesions caused by human papillomavirus (HPV). We aimed to assess the effectiveness and tolerability of imiquimod suppositories for the treatment of anal high-grade intraepithelial lesions (HSIL) and condylomas in HIV-infected patients. We conducted a retrospective analysis in a prospectively followed cohort. High-resolution anoscopy was used for diagnosis and assessment following treatment. Patients’ tolerability was assessed with a self-administered survey. Ninety-five patients (94.7% men) were analyzed. All were on combination antiretroviral therapy. Median CD4 T-cell count was 690 cells/µL, 89% had undetectable plasma viral load. Response to imiquimod was seen in 46.3% (complete: 12.5%, partial: 33.8%) in the intent-to-treat analysis, and in 55.2% (complete: 14.9%, partial: 40.3%) in the on-treatment analysis. Higher response rates were observed for anal condyloma compared with HSIL. A significantly poorer response rate was observed in smokers and in individuals with lower nadir CD4 T-cell counts. Imiquimod tolerability was “good” in 57.1% (n = 36), “acceptable” in 33.3% (n = 21), and “poor” in 9.5% (n = 6). Systemic side effects were reported in 20.7% (n = 13). There was no association between treatment effect and tolerability. In conclusion, imiquimod stands as a well-tolerated option for the treatment of HPV-associated intra-anal pathology in HIV-infected individuals.

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“…Carbon dioxide laser therapy is the most effective treatment in achieving complete clearance, but subsequent treatment with surgical ablation most effectively decreases the recurrence risk of anogenital warts (Barton et al, 2019). However, ablation is not recommended in patients with extensive disease and bleeding disorders or on anticoagulant therapy (Megill & Wilkin, 2017).…”

Section: Diagnostic Criteria and Treatmentmentioning

confidence: 99%

Skin Cancer Back to Basics

Dhillon

Lake

2022

Journal of the Dermatology Nurses' Association

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Anogenital squamous cell carcinoma is rare but an often-invasive malignancy that is becoming an increasingly prevalent public health problem. Infection with high-risk human papillomavirus variants plays a critical role in disease progression and occurrence. Immunosuppressive treatment, positive HIV status, number of sexual partners, and history of smoking increase neoplastic progression. Early diagnosis and treatment are pivotal in managing anogenital malignancies to improve quality of life and minimize extensive surgical excision. This article reviews lesion categorization, epidemiology, human-papillomavirus-driven dysplastic epithelial changes, risk factors, diagnostic criteria, treatment options, and prophylactic measures to improve patient outcomes.

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

Cited by 17 publications

References 49 publications

Anal intraepithelial neoplasia: diagnosis, screening, and treatment

Anal intraepithelial neoplasia: diagnosis, screening, and treatment

The effectiveness and tolerability of imiquimod suppositories to treat extensive intra-anal high-grade squamous intraepithelial lesions/warts in HIV-infected individuals

Skin Cancer Back to Basics

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