OBJECTIVES A retrospective audit has been undertaken of Squamous (epidermoid) type of anal cancer diagnosed and treated in the principality of Wales over a five-year period (1995-99) with follow-up until 2005. The referral pattern, distribution, presenting symptoms, predisposing conditions, clinical findings and staging modalities were documented. The surgical and oncological treatment together with their outcome was analysed. METHODS Patients were identified from the Welsh Cancer Registry and the pathology databases of the 17 acute hospitals in Wales. Data was collected from the clinical and oncology case notes onto a purpose designed Microsoft access database. RESULTS There was a wide variation in data quality from the individual units. Twenty-six anal cancers were diagnosed per year in the region. Median age was 69 years. Ten percent had documented perianal Human Papilloma Virus related disease. Radiology was inconsistently used for staging. Eighty percent were referred for an oncology opinion; 50% had chemo-radiotherapy with a curative intent. The over-all Stoma rate was 35% and of these 18% had an abdomino perineal resection. The overall five-year survival was 45%. CONCLUSIONS This is a unique regional audit of anal cancer. Improvements need to be made in documentation particularly of staging, treatment, pathology reporting and outcome. This study concurs that Human Papilloma Virus appears to predispose to Squamous anal cancer. Radiological staging needs to be standardized according to best clinical practice. As recommended by NICE all patients should be referred to a multidisciplinary anal cancer team, which can provide individual treatment plans. Increased specialization could mean specialist regional MDTs for anal cancer.