Management of High-Grade Squamous Intraepithelial Lesion (Formerly Bowen Disease) and Paget Disease

Introduction

Malignancies of the anus, anal canal, and perianal skin include epidermoid carcinoma, malignant melanoma, squamous cell carcinoma, adenocarcinoma, and basal cell carcinoma. From 2006 to 2010, the number of new cases of anal cancer was 1.7 per 100,000 men and women per year. The number of deaths was 0.2 per 100,000 men and women per year. This chapter focuses on perianal intraepithelial squamous cell carcinoma and perianal intraepithelial adenocarcinoma. These conditions present subtly, and affected patients may present with other diagnoses after protracted medical therapy has failed to relieve their symptoms. Prompt diagnosis requires awareness of these conditions and a high index of suspicion.

The symptoms produced by neoplasms of the perianal and anal skin frequently mimic those of more common benign inflammatory conditions. Patients may be asymptomatic or may report pruritus, burning, pain, bleeding, drainage, or a sensation of a mass. Failure to investigate these common symptoms may result in a delay in the diagnosis of a malignant tumor. Performing a biopsy of all nonhealing lesions, atypical rashes, or perianal growths is important, with subsequent cytologic and histologic examination by a skilled pathologist.