Not all comedones are facial: Rare perianal lesions

Abstract

A 74-year-old white gentleman with a history of colon polyps presented for surveillance colonoscopy. On digital rectal examination he had dark perianal lesions noted. Upon insertion of colonoscope images of perianal lesions (figures 1 and 2) and normal appearing anus (figure 3) were taken. Colonoscopy was completed without difficulty and showed normal terminal ileum, a medium-sized sigmoid lipoma, diverticulosis, internal hemorrhoids and four polyps (tubular adenomas). He was referred to Dermatology for evaluation of perianal lesions. He reported slight enlargement over several years, asymptomatic except for frequent wiping, and not obstructive with bowel movements. He denied use of topicals. His sexual history was unremarkable and reported no personal or family history of skin cancer. On perianal