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Session: ePoster: Colon and Colorectal Cancer 5 (Sun225)

EP496 - A Rare Basal Cell Carcinoma of the Anus in a 69-year-old Male Presenting with Rectal Bleeding – A Case Report

Sunday, May 11, 2025
2:30 PM – 2:35 PM PT
Location: Monitor 5, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Michael S. Gerges, DO

    Resident Physician
    Jefferson Northeast/Philadelphia College of Osteopathic Medicine
    Philadelphia College of Osteopathic Medicine
    Newark, DE, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • JL

    Jason Lei, MD

    Division Chief of General Surgery
    Jefferson Health System
    Hopewell, New Jersey, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Michael S. Gerges, DO: This individual has no financial relationships with ineligible companies.
Jason Lei, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Basal cell carcinoma (BCC) of the perianal region is an exceedingly rare type of cancer that is otherwise common in the rest of the body (about 50% of non-melanoma skin cancers in total). There has only been fewer than 200 cases reported worldwide. BCC typically arises in areas that are frequently exposed to sunlight due to ultraviolet radiation damage, so it most commonly appears in the head and neck areas. It has been predominantly linked to the elderly population and usually presents as a slow growing localized skin lesion that usually has the appearance of an exophytic fleshy mass. Unlike squamous cell carcinoma which is usually aggressive and has high risk of metastasis, BCC rarely metastasizes and the mortality rate is extremely low ( < 0.1%).

Methods/Interventions: A 69-year-old male with a past medical history of diabetes and hemorrhoids who presented to the office after a referral from his PCP. The patient has been experiencing anal pain, mucous discharge and intermittent bright red blood per rectum. Rectal exam in the office demonstrated an ulcerated left sided perianal mass extending up about 2 cm with associated anal stenosis. The patient then underwent an elective rectal EUA in the operating room for better examination of his perianal lesion. The lesion was visualized in its entirety in the operating room and was excised completely. He was then discharged the same day.

Results/Outcomes: The pathology analysis demonstrated abundant nests of malignant basaloid tumor cells positive for AE1/AE3, p63, CK5/6 and BerEP4 while negative for CK20, CDX2, CEA and EMA. These histomorphology and immunohistochemical findings were consistent with basal cell carcinoma. Patient was referred for medical oncology follow up and is currently doing well with no wound or incontinence issues.

Conclusion/Discussion: Basal cell carcinoma is a very common type of skin cancer with favorable prognosis, yet its occurrence is very rare in the perianal region. Out of all the reported perianal BCC, there was 0% mortality observed. Most patients were treated with wide local excision with recurrence rate under 8%. For those who had recurrence, most were able to get repat excision with very few patients who needed an abdominoperineal resection due to the inability to save the anal sphincter.
With a very few cases reported worldwide, it is unclear what are the risk factors for perianal BCC since the area is not commonly exposed to ultraviolet radiation. However, it was noticed that from all the cases reported, hemorrhoids, anal fistulas and history of pelvic radiation were not uncommon among the affected patients.
To conclude, BCC is a rare perianal cancer, but it can be challenging due to its resemblance to other diseases.