1. Presented by Peter Illei, M.D. and prepared by Kara Judson, M.D.

This is a 76-year-old female patient with a very complex past medical history that includes multiple forms of cancer as well as hypertension, peripheral vascular disease, chronic renal insufficiency, and diabetes. She had a hysterectomy in 1965, left mastectomy form Paget"s disease of the left nipple with an associated 2.4 cm in situ and infiltrating duct carcinoma, and a 0.9 cm adenocarcinoma of the sigmoid colon in 2004. She now complains anal discomfort and has reddened and thickened anal mucosal/skin lesions that were biopsied and subsequently excised.