A Melanotic Sarcoma of the Anal Region

Local examination.?A bliud external fistula with thick hard margins on the left side of the anus was seen. There were a few black granules at the bottom of_ the fistula. Per rectum, a hard irregular mass chiefly occupying the posterior wall of the rectum and anus could be felt. It was continuous with the hard mass forming the fistula outside the anus. The growth was partly movable from side to side, and bled on examination. Haemorrhoids were present. The prostate was enlarged and smooth. The inguinal glands were very slightly enlarged, freely movable, discrete and painless. Lumbar glands were impalpable. Clinical examination of other parts of the body did not indicate any evidence of metastasis. Under chloroform, after preliminary preparation, the sphincter ani was dilated and the tumour drawn out of the anal orifice and completely excised. It was about the size of an ordinary orange, irregular in shape, hard in consistency and dark purple in colour except a small patch which was black. The piles were ligatured and excised. The tiny mass with a fistula in it located outside the anus was removed as thoroughly as possible. . .