A mysterious anus

A 74-year-old man presented at the consultation of gastro-enterology with a painfully ear-shaped swelling (Fig. 1A and 1B) around the anus. He denied fever, weight loss, or diarrhea. His medical history included coronary artery disease, arterial hypertension, atrial -fibrillation,- melanoma- on- the- lower- back- with- curative resection, a total hip replacement on the left side and knee prosthesis on both sides. Current medication use included acetylsalicylic acid 80 mg, bisoprolol 2,5 mg and acenocoumarol 2 mg. Several biopsies were taken and-showed-aspecific-polypoid-granulation-tissue-without any sign of malignancy. Echo-endoscopy revealed no invasion in the surrounding muscular layers. A left-sided colonoscopy showed no abnormalities. Finally, the le- sion was surgically removed.