How do you manage patients with history of multiple perianal condylomas who develop focal high grade squamous intraepithelial lesions in the anal margin?  

In the absence of invasive disease, surgical resection is always the treatment of choice for in-situ disease.  If the recommendation is APR, it should be well documented. If the patient refuses the surgical option, then radiation can be offered with very careful documentation. The reason for th...

In the era of AIDS related malignancies, this was not an uncommon problem.  We would get a PET/CT and would be surprised by those results.  For instance, we had a patient with no evidence of invasion on any biopsies in the anus, and a node in the inguinal area was PET hot, resulting in a d...