Below are random questions:

1) I have frequently observed flat acetowhite changes perianally with what appears to be superficial erosions with fine punctation at the base, always after vinegar soaking.  I have assumed that this is simply consistent with diffuse HPV infection of the skin.  Can you comment/elucidate?  (Unfortunately my agency still has not enabled photodocumentation so I do not have anything I can show you at this time.)

2) I heard someone during the course comment about ablation of anal papillae particularly if they are obstructing needed visualization of potential high-grade lesions.  Is this amenable to an office hyfrecation or it should be done by a surgeon (who can place a suture if needed) and/or in the OR?

3) I have also observed proximal to the squamocolumnar junction/transformation zone what appears to be islands of what I am calling squamified columnar mucosa in the distal rectum.  I have noticed that this tends to be associated with a history of receptive anal intercourse.  Since it often still has visible rectal villous architecture, it is a bit difficult to identify dysplastic features other than by the presence of atypical vascularity.  Can you please comment/clarify?

4) are there any alternatives to using Lugol's solution in patients who report an allergy to iodine?