Anal Bowen's disease is squamous cell carcinoma in situ occurring in the anal canal or perianal skin and was a rare finding before the human immunodeficiency virus epidemic. Bowen's disease is synonymous with high-grade intraepithelial neoplasia. The pathophysiology and natural history of anal Bowen's disease are analogous to cervical dysplasia. The risk for anal dysplasia is increased in individuals with human papilloma virus infection. Clinical evidence suggests that low-grade anal intraepithelial dysplasia and squamous cell carcinoma in situ are precursors to invasive squamous cell carcinoma. The treatment of Bowen's disease has shifted away from aggressive wide local excision. Current strategies for management of anal dysplasia include surveillance in high-risk individuals with targeted biopsies and destruction of discrete lesions.
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