Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Located at or outside the anal verge• Usually well-differentiated, keratinizing tumors• Behave similarly to squamous cell carcinomas of skin• Lesions may be present for long periods before symptoms develop• 4 types -Squamous cell-Basal cell-Bowen disease-Paget disease +++ Epidemiology + • Squamous, basal cell carcinoma, and Bowen disease more common in men• Paget disease more common in women• 50% patients with Paget disease have coexistent GI malignancy +++ Symptoms and Signs + • Mass• Bleeding• Pain• Discharge• Itching• Tenesmus• Lesions may be quite large with central ulceration• Paget disease: Erythematous, eczematoid rash• Basal cell: Raised edges with central ulcer• Bowen disease: Scaly, erythematous, sometimes pigmented; often associated with condylomas in younger patients +++ Laboratory Findings + • Pap smear screening may be useful to detect dysplasia in immunocompromised patients +++ Imaging Findings + • CT/MRI: Reveal anal mass• Endorectal US: Reveals size and depth of invasion and perianal nodes + • Chronic or nonhealing perineal ulcer• Anal canal cancer• Perianal abscess +++ Rule Out + • Biopsy all chronic or nonhealing perineal ulcers + • Physical exam with digital rectal exam• Assessment for lymph adenopathy (groins)• Exam under anesthesia, anoscopy with biopsy• Endorectal US to assess size and depth of invasion• Chest film, CT to assess for metastatic disease +++ When to Admit + • Intractable symptoms: Pain• Severe bleeding with hemodynamic compromise + • Mainstay of treatment is surgical (wide excision)• Chemoradiation useful for aggressive lesions +++ Surgery +++ Indications + • Small, well-differentiated lesions (< 4 cm) may be treated with wide excision• Large, deep lesions involving sphincters require abdominoperineal resection (APR)• Grossly involved lymph nodes should be resected• Recurrences may be treated with reexcision or APR• For Bowen disease: Wide local excision and 4-quadrant biopsy• For Paget disease: Wide local excision and multiple perianal biopsies +++ Medications + • Chemoradiation may have a role in advanced disease +++ Treatment Monitoring + • Surveillance physical exam with rectal exam and lymph node exam +++ Complications + • Infection/perianal sepsis• Fistula +++ Prognosis + • Squamous cell carcinoma: T stage determines survival; 5-year survival T1 (100%), T2 (60%)• Basal cell carcinoma: Metastasis is rare; local recurrence is 30%• Bowen disease: invasive squamous cell carcinoma develops in fewer than 10% of cases +++ References ++Peiffert D et al: Conservative treatment by irradiation of epidermoid carcinomas of the anal margin. Int J Radiat Oncol Biol ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.