Purpose: A 19-year-old female was evaluated for loose stools of several years duration. Lab work revealed a normal hematocrit, c-reactive protein, albumin, and erythrocyte sedimentation rate. Stool studies were negative for infection. A colonoscopy found severe pancolitis consistent with ulcerative colitis (UC). Systemic steroids and a 5-aminosalicylic acid derivative were initiated. Repeat colonoscopy 6 months later was significant for a carpet like lesion at 25 cm from the anal verge in an otherwise normal appearing colon. Biopsies contained low grade dysplasia within the lesion and the surrounding mucosa, consistent with a dysplasia associated non-adenoma like lesion or mass (DALM). The patient underwent a total proctocolectomy with J pouch formation and ileoanal anastomosis. Upon follow up she was doing well. In inflammatory bowel disease (IBD), dysplasia is defined as unequivocal neoplastic epithelium that is confined to the basement membrane without invasion into the lamina propria. The rate at which colitic mucosa progresses to dysplasia, and ultimately to colorectal cancer (CRC) is unknown. The molecular biology of cancer in IBD is unique in that the accumulation of molecular and genetic alterations may occur more rapidly or in an unconventional sequence when compared to sporadic CRC. The duration and extent of colitis, early age of onset of colitis, family history of CRC, coexistent primary sclerosing cholangitis, and severity of microscopic inflammation are risk factors for the development of cancer in UC. Elevated lesions that are endoscopically visible, but not amenable to endoscopic resection are referred to as dysplasia associated lesion or mass (DALM). In a series of 12 patients with a DALM who underwent colectomy, 7 were found to have invasive carcinoma. One in 8 patients with UC will have dysplasia or cancer found on their initial screening colonoscopy. Patients with greater than 10 years of disease and those with extensive disease (pancolitis) are at highest risk for cancer. The incidence rate increases with each successive decade of disease activity, with cumulative probabilities of 2% at 10 years, 8% at 20 years, and 18% at 30 years. More recent data suggests that the risk may be on the decline with 0.6% after 10 years, 5.4% after 20 years, and 7.5% after 30 years of chronic UC. We present a case of UC with findings of a DALM that led to proctocolectomy only 6 months after the diagnosis of pancolitis in a 19-year-old patient. This presentation of a DALM is unusual because of the short duration of known UC and the patient's young age.