Atypical anal itching lesion associated with a protruding rectal polyp

An 83-year-old male presented at the gastroenterology clinic with complaints of anal itching associated with a reducible, protruding rectal mass that had been bleeding on contact for the past few months. Clinical examination revealed two erythematous, slightly nodular, eczema-like lesions measuring 3 cm and 2 cm, extending laterally from the anal margin. (Figure 1, Panel A) A digital rectal exam revealed a small, soft mass in the posterior lower rectum. Total colonoscopy identified a 25 mm sessile polyp classified as CONECCT 2C (1) in the lower rectum (Figure 1, Panel B). Biopsies of the anal margin lesions were obtained using a cold forceps.