Anogenital Area Should Also Be Examined
Admittedly, the anoderm (the lining of the lower part of the anal canal) and the perianal skin account for only a minute proportion of the body’s 2 m2 skin surface. We missed in the interesting article (1) any mention of the fact that especially HPV-associated cancers and precancerous lesions (anal [AIN] and vulval [VIN] intraepithelial neoplasias) in the anogenital region are notably more common in immunosuppressed patients (not only medication-induced immunosuppression, but also infection-related immunosuppression [HIV]) (2–4). Since one generally gets the impression, that nowadays many diseases are treated with biological medications that affect the immune system, an increasing incidence of such skin tumors (cancers and precancerous lesions) might be expected in such diseases as well (Crohn’s disease, psoriasis, multiple sclerosis, rheumatoid arthritis, etc). As has been suggested for HIV patients (2), otherwise immunosuppressed patients should also have regular proctologic, urologic, and gynecologic examinations if these were not done at the dermatologic examination.
Dr. med. Johannes Jongen
Prof. Dr. med. Volker Kahlke
Proktologische Praxis Kiel
Abteilung Proktologische Chirurgie
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Ulrich C, Arnold R, Frei U, Hetzer R, Neuhaus P, Stockfleth E: Skin changes following organ transplantation—an interdisciplinary challenge. Dtsch Arztebl Int 2014; 111: 188–94 VOLLTEXT|
|2.||AWMF-Leitlinie: Anale Dysplasien und Analkarzinome bei HIV-Infizierten: Prävention, Diagnostik und Therapie. http://www.awmf.org/leitlinien/detail/ll/055–007.html (last accessed on 15 March 2014)|
|3.||Scholefield JH, Harris D, Radcliffe A: Guidelines for management of anal intraepithelial neoplasia. Colorect Dis 2011; 13 (Suppl 1): 3–1 CrossRef MEDLINE|
|4.||Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD, on behalf of the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice Parameters for Anal Squamous Neoplasms. Dis Colon Rectum 2012; 55: 735–49 CrossRef MEDLINE|