Introduction Most commonly squamous cell cancer others include: transitional cell, adenocarcinoma, melanoma, mucoepidermal Risk factors include fistulas abscess infections Crohn's disease Bowen's disease is squamous cell carcinoma in situ Paget's disease is adenocarcinoma in situ Presentation 25% asymptomatic Anal bleeding Pain Muscus per recturm Pruritus Evaluation Anoscope Biopsy Treatment Adjuvant chemo (NIGRO protocol: 5FU and Mitomycin) and radiation Bowen's Disease: treat with wide local excision Paget's Disease: treat with wide local excision Prognosis, Prevention, and Complications 90% have complete response to chemo 85% five year survival with NIGRO Anal melanoma: 5 year survival is < 5%