Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local excision. Stage T2 lesions have a significant risk of inguinal lymph node metastases and should be treated with radiotherapy to the primary tumor in conjunction with elective inguinal lymph node irradiation. The best treatment for T3 and T4 lesions is radiotherapy to the primary lesion and regional nodes (inguinal and pelvic) combined with concomitant chemotherapy. Abdominoperineal resection (APR) should be reserved for patients who have fecal incontinence at presentation or locally recurrent disease after previous radiotherapy.