Introduction 1 2 3 1 4 5 6 Case report A 62-year-old black man with a history of prostatism was referred to our hospital by his general practitioner with the diagnosis of bleeding hemorrhoids. For a 10-week period he noticed a swelling protruding from the anus with daily bleeding from the anus. Defecation was problematical because of pain, but the stool had a normal aspect. Inspection of the anus showed a painful swelling with a diameter of 1.5 cm with a dark necrotic aspect surrounding the anus below the dentate line. Rectal palpation was impossible because of pain. At the outpatient department the swelling was excised under local anesthesia of the entire anus (anal block). Because of the atypical aspect of the swelling, the material was submitted for pathologic examination, which revealed a melanoma of the anus. Further staging of the tumor was not possible based on this material because of fragmentation of the tissue. 1 1 Fig. 1 Melanoma of the anus: wide local excision. A=melanoma  Discussion 4 , – – 7 – 11 12 et al 12 et al 5 et al 13 13 15 et al 16 6 17 5 3 et al 18 et al 19 In conclusion, anorectal melanoma represents both a diagnostic and therapeutic challenge to physicians given its non-specific presentation and rarity. It is associated with poor prognosis, regardless of the type of intervention used. Therefore, the overall treatment goal should be to optimize the quality of life. Since wide local excision is a more limited intervention associated with at least comparable survival compared to APR and no need for permanent colostomy, wide local excision is recommended as primary therapy if negative surgical margins can be achieved. APR should be reserved for patients in whom the tumor is thicker than 4 mm and/or involves the anal sphincter.