A Yankee in King Arthur's court, or an anal dysplasia NP within a colorectal surgery practice

Abstract

Background: Having been an HIV NP in upstate NY between the years of 1998 and 2009, it became apparent that High Resolution Anoscopy (HRA), was needed. Methods: The University of Rochester and NYS Department of Health AIDS Institute provided the means for me to learn HRA and Infrared Photocoagulation (IRC) ablation of High Grade Squamous Intraepithelial Lesions (HSILs). The task was then to find a “home” in Rochester for this practice. Results: Rochester Colon and Rectal Surgeons (RCRS), a private surgical practice, agreed in 2005 to let me establish an anal dysplasia practice within their eight surgeon group. 12+ years later, this anal dysplasia practice has screened and treated over 2000 patients. Initially, all referrals were HIV+ MSM, followed by HIV- MSM, HIV + women, and most recently HIV- women who have had cervical cancer or high grade dysplasia. Referrals come to me from HIV providers, Gynecologists, GYN Oncologists, Gastroenterologists, General Surgeons, Dermatologists, PCPs, and the colorectal surgeons within my own practice.In 2017, an monthly Anal Dysplasia Conference was convened to provide for citywide interdisciplinary (Pathologists, GYN Oncologists, Colorectal Surgeons and interested others) to review clinical findings, as well as to provide clinical correlation with projected cytology and pathology. Conclusions: This anal dysplasia practice has resulted in the diagnosis, not only of HSILs and cancer, but also adenoma, lymphoma, primary squamous rectal cancers, molluscum, syphilis, as well as a plethora of the usual STDs.No regularly screened patient has developed squamous cell carcinoma within the anal canal, although two have developed squamous cell carcinomas of the anus.