© 2012 Springer-Verlag London Limited. Anal cancer comprises 1% of lower gastrointestinal tract cancers with approximately 800 reported new cases per year in the UK. Nearly all cases are of epidermoid type (squamous, basaloid, or cloacogenic); malignant melanoma, and other primary malignancies are very rare and respond poorly to any treatment modality. Anal canal lesions are twice as common as margin cancers; canal lesions are twice as common in women with the reverse ratio for margin lesions. The distinction between the two lesion sites is clinically important for two reasons: firstly, that canal lesions can invade adjacent organs (vagina, urethra, prostate, and bladder) and may require different treatment strategies and, secondly, that T1 margin lesions can be excised locally. Presenting symptoms include pain (49%), bleeding (44%), change in bowel habit (34%), a mass (24%), and pruritus/discharge (23%) .