Anal cancers are relatively uncommon at around 2% of large bowel cancers. Squamous cell carcinoma is the most frequent. Squamous cell carcinomas (including the basal cell variant) are associated with high risk Human Papilloma Virus (HPV type 16) infection and occur most frequently in high risk groups such as males with male sexual partners, immunodeficient patients due to HIV or to immunosuppressive therapy and women with a history of HPV associated cervical squamous intra-epithelial lesions. Anal intraepithelial neoplasia is a precursor. Verrucous carcinoma is also known as giant condyloma acuminatum and represents low malignant squamous cell carcinoma, associated with low risk HPV types (6 and 11). Rare primary tumors of the anal canal are extramammary Paget’s disease and anal melanoma.