Anal cancer is a rare but increasingly common malignancy worldwide. Human papilloma virus (HPV) infection and squamous intraepithelial lesions (SIL) are recognized as the predominate precursors for the development of anal SCC, but the surveillance and treatment of SIL remain complex and controversial. Chemoradiation remains the mainstay of treatment for anal SCC, with the majority of patients experiencing complete remission. Abdominoperineal resection and lymph node dissection offer salvage therapy for patients with residual or recurrent disease.