LAUSR

Intraepithelial neoplasia of the lower genital tract, perineum and perianal area is most often linked to the prevalence of human papillomavirus (HPV) infection [1]. HPV predisposes to precancerous lesions involving the cervix, but less commonly the vagina, vulva and anus. Left untreated, anal intraepithelial neoplasia (AIN) and vulvar intraepithelial neoplasia (VIN) can progress to invasive cancer; with longterm progression of approximately 10% [2]; risk is highest in those who smoke, have multifocal disease or are immunocompromised [1]. Treatment strategies vary, and range from watchful waiting to radical excisional surgery, but irrespective of modality, up to 50% of patients will develop recurrence [3]. Recurrence is significantly lower with clear surgical margins [3], although lymph node clearance is not necessary. In the current study, we report a novel therapeutic strategy for extensive multifocal high-grade intraepithelial neoplasia involving complete surgical resection of disease with perineal reconstruction and formation of a neo-anal opening.