Voorstadia van anuscarcinoom: Opgespoord met hogeresolutieanoscopie

The incidence of anal carcinoma has increased significantly in recent decades, and is mainly found among HIV positive men who have sex with men (MSM). Precursor stages of anal carcinoma, Anal Intraepithelial Neoplasia (AIN), can be detected early by High Resolution Anoscopy (HRA), and if necessary treated. With the increased life expectancy of HIV patients, the need for HRA will increase further. Dermatologists are well equipped to perform HRA. In addition to experience in performing anoscopy, the visual expertise in assessing skin abnormalities is an advantage when assessing the often subtle AIN lesions. In the coming years colleagues will have to be trained to perform HRA. Bottlenecks in the roll-out of HRA diagnostics are: 1) efficient selection of patients who have to undergo HRA, 2) training of HRA anoscopists, and 3) new treatment options for patients with high grade AIN (HGAIN). This article discusses these 3 points in more detail. The anal carcinoma incidence among MSM could be reduced drastically in the future when gender-neutral prophylactic HPV vaccination is introduced. Because HIV-positive MSM are most commonly affected by anal carcinoma and do not benefit from the induced herd-immunity from vaccinated girls, gender-neutral vaccination could offer a solution in the prevention of anal carcinoma in future generations.