A woman in her 80s was referred to our clinic after she noticed her first-ever episode of bright-red blood exuding from her rectum while defecating. She reported regular bowel movements and denied gastrointestinal symptoms, night sweats, fever, chills, and weight loss; she had never had a colonoscopy. Physical examination of the vulvar and vaginal tissue showed no abnormalities. However, examination of the perianal mucosa revealed bilateral, well-demarcated, beefy red plaques (Figure, A). The tissue in the left perianal region was elevated with a firm, nontender, papular component. In addition, there was overlying mucopurulent discharge but no obvious bleeding. The patient had been in a monogamous relationship for more than 50 years, and no previous serologic testing for syphilis had been done. Subsequently, a 5-mm punch biopsy of the lesion was performed (Figure, B and C).
Mitkov M, Pimentel J, Bruce A. Beefy Red Plaques in the Perianal Region. JAMA Dermatol. 2014;150(4):447-448. doi:10.1001/jamadermatol.2013.7639