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Anogenital malignancies and premalignancies: Facts and controversies

机译：肛门生殖器恶性肿瘤和恶变前疾病：事实和争议

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Anogenital malignancies and premalignancies are an important personal/public health problem due to their effects on individuals' physical, mental, and sexual health. Also, due to their etiological association with human papillomavirus (HPV) infection, anogenital malignancies and premalignancies constitute an immense public health burden. In addition to HPV infection, immunosuppression, HIV infection, chronic dermatoses, such as lichen sclerosis, previous radiotherapy and chemotherapy treatments, and smoking, are the other important etiopathologic factors in the development of anogenital malignancies and premalignancies. The incidence of anal squamous cell carcinoma (SCC) has increased considerably in the past decade, mainly due to the growing number of cases in high-risk groups, such as men who have sex with men, immunosuppressed individuals, and patients with HIV infection. Also, an increase in vulvar intraepithelial neoplasia (VIN) and VIN-related invasive vulvar cancer has been noted in women younger than age 50 years due to its association with HPV infections over the past decade. SCC of the scrotum seems to be the first cancer linked to occupational exposure. Bowen's disease, Bowenoid papulosis, and erythroplasia of Queyrat are the most widely seen premalignancies of anogenital region and are all forms of squamous intraepithelial neoplasia. Histopathologically, these conditions share identical histologic features of SCC in situ, but their clinical features differ. Early diagnosis is vital to improve prognosis, especially in anogenital malignancies. Also, if a delay occurs in diagnosis, treatment options used will be associated with significant negative effects on the patient's psychological well-being and quality of life; hence, management of anogenital malignancies and premalignancies should be organized in a multidisciplinary fashion.
机译：肛门生殖器恶性肿瘤和恶性肿瘤是一个重要的个人/公共健康问题，因为它们会影响个人的身体，心理和性健康。而且，由于其与人类乳头瘤病毒（HPV）感染的病因学联系，生殖器恶性肿瘤和恶性肿瘤构成了巨大的公共卫生负担。除HPV感染外，免疫抑制，HIV感染，慢性皮肤病（如地衣硬化），以前的放射疗法和化学疗法以及吸烟是生殖器恶性肿瘤和恶变前期发展的其他重要病因。在过去的十年中，肛门鳞状细胞癌（SCC）的发病率显着增加，这主要是由于高危人群（例如与男性发生性关系的男性，免疫抑制的个体以及HIV感染患者）的病例数增加。此外，由于在过去十年中与HPV感染相关，年龄在50岁以下的女性中外阴上皮内瘤变（VIN）和VIN相关的浸润性外阴癌的发病率也有所增加。阴囊的SCC似乎是第一个与职业接触有关的癌症。 Bowen病，Bowenoid丘疹和Queyrat的红斑是肛门生殖器区域最常见的癌前病变，均为鳞状上皮内瘤变。在组织病理学上，这些疾病在原位具有相同的SCC组织学特征，但是它们的临床特征不同。早期诊断对改善预后至关重要，尤其是在肛门生殖器恶性肿瘤中。另外，如果诊断延迟，则所使用的治疗方案将对患者的心理健康和生活质量产生重大的负面影响。因此，应以多学科的方式组织肛门生殖器恶性肿瘤和恶性肿瘤的管理。

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