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JAMA Dermatology Clinicopathological Challenge
February 12, 2020

A Treatment-Refractory, Perianal Tumor Arising in an Otherwise Healthy Older Adult Woman

Author Affiliations
  • 1Department of Dermatology, Oregon Health and Science University, Portland
JAMA Dermatol. 2020;156(4):453-454. doi:10.1001/jamadermatol.2019.4823

A woman in her 80s presented with an 8-month history of a growing, painful tumor on her right buttock. The patient felt well otherwise and denied experiencing fevers, chills, sweats, weight loss, or malaise. Her medical history was notable for chronic kidney disease and genital herpes simplex virus (HSV). She reported no history of genital warts, HIV, or inflammatory bowel disease. A biopsy was performed, and results were consistent with a noninfectious, granulomatous ulcer. Based on the clinical appearance and prior pathologic findings, the patient received treatment of oral antibiotics, intralesional steroids, topical steroids, and immunomodulators, without improvement. Findings from colorectal surgical evaluation of the internal anal mucosa were negative for malignant neoplasm.

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