Anal Intraepithelial Neoplasia
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Anal intraepithelial neoplasia, a premalignant condition, is a difficult problem of the anal canal and margin. The disorder most commonly causes no discernible symptoms; yet patient concern and treatment uncertainties render anal intraepithelial neoplasia challenging to treat. Treatment difficulties are related to adequately tailoring care to the patient, without over- or undertreating the problem. At this time, the regimen most commonly practiced by physicians with experience in treating anal neoplasia is close follow-up through careful examination unless other factors force intervention. Those patients with symptoms, immunosuppression, past history of high-grade disease, and other difficult social factors warrant more aggressive care. When intervention is needed, a targeted approach to dysplasia ablation is more of tissue sparing than the historically practiced wide local excisions and flap advancements. Excellent outcomes are obtained when an experienced clinician is involved in the care of engaged patients who follow recommendations.