Anal squamous cell carcinoma: An evolution in disease and management

Table 2 Treatment of anal intraepithelial neoplasia

Therapy	Pro	Con	Ref.
Watchful waiting	Avoids the morbidity of other therapies	Missed opportunity to potentially cure patient	[7]
	Low risk of interval development of carcinoma (for low-grade)	Need for close surveillance and reliable patient
Topical imiquimod	Response rate of 48%-86%	Burning, irritation, variable patient compliance	[14-16]
		Recurrence or new lesions in untreated areas
Topical 5-florouracil	High response rate, up to 90%	High recurrence rate, up to 50%	[17,18]
Wide local excision	Recurrence rates as low as 13% reported	Significant morbidity of anal stenosis, wound healing and incontinence	[19-21]
Targeted therapy with HRA	Evidence to prevent progression to anal cancer	High rate of persistent or recurrent disease in HIV positive patients	[22-24]
	Avoid anal stenosis and incontinence

HRA: High-resolution anoscopy; HIV: Human immunodeficiency virus.