How do you manage squamous cell carcinoma in situ of the anus?

The first question I always ask when I get a case of in-situ squamous cancer is it reallly in-situ? If the physical examination suggests an invasive cancer or if the visible disease is very superficial but extensive, then it may be a sampling error and a few more biopsies are indicated.

Assuming that's been done, then my next question would be is the disease amenable to a low morbidity local excision? Often enough of the anal circumference is involved to make the surgical management more likely t...