Dear faculty,

I have noted some questions that came up listening to the lectures and also from practice:

0) Regarding the lecture "ABC of Advanced HRA": What is the proportion of lidocaine and adrenaline used? Do other providers also use local anestesia buffered with adrenaline before ablating lesions?

1) According to IANS quality metrics for the metric histological HSIL diagnoses per year, should we consider individually each HSIL lesion diagnosed in the same patient or HSIL lesions diagnosed in different patients?

2) For anal or perianal HSIL is 5FU more effective/more tolerable than imiquimod in your opinion?

3) During a regular proctology appointment, patient without indication for anal dysplasia screening. I observe a lesion that I think may be at least HSIL. Does it add to the diagnosis if I apply acetic acid prior to biopsy? Or should I refer the patient to HRA? 

4) A patient with a perianal eczema if we apply acetic acid is it also AWE?

5) What type of operative management is recommend for HSIL in fistula or sinus tracts?

6) Regarding case 2 of the lecture "Surgical management of early anal and perianal cancers" by Dr Rebecca Levine was it reasonable to refer the patient for CRT without undergoing surgical excision? Does surgical excision delay the beginiing or increase risks of CRT?

7) Is CRT for SCC also effective for remaining HSIL lesions? 

8) How do you envision the ideal follow up of a patient after CRT? Just regular anuscopy according to NCCN recommendations or should we perform HRA if available?

Thank you for your help