What causes a hyperpigmented lesion on the inner border of the anal sphincter in a 32-year-old woman?

Question

Hello doctor,

I am a 32-year-old female, relatively healthy. However, I have a history of chronic cough and exertional dyspnea, for which I see a respirologist. PFT is not conclusive, showing borderline low lung volumes and diffusing capacity, possibly restrictive lung disease. However, the doctor said I do not have any risk factors for developing restrictive lung disease, and he will treat it as asthma until the next assessment. Medications include Zenhale and Ventolin only.

My query is regarding a dark, hyperpigmented lesion in the anal inner border. It looks like a mole, but I want an expert dermatologist's opinion as I did not get it checked by any doctor. It is a symmetrical homogenous lesion. It does not show externally, as it is on the inner border of the anal sphincter. It appears when I bear down. I have a history of recurrent multiple anal fissures attributed to chronic constipation and IBS. I had a colonoscopy two years ago, which was clear. I have a large skin tag. The main fissure locations are midline, but once it heals, it becomes a skin tag. Then, when I got other new fissures, I got them off-midline. But I think I got these fissures due to the large skin tag in the midline area, which is scarred and, therefore, not prone to develop fissures (in scarred tissue). Just to note, when I get multiple fissures, it is not all at the same time. I mean by multiple is different locations but not during the same period. I can attach a picture of the suspected lesion.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

From the attached images (attachments removed to protect the patient's identity), I can only make a probable diagnosis. That can either be a skin tag or papilloma. For proper diagnosis, you need a proctoscopic examination. Do you have a history of constipation? Regarding the black spot, I cannot pick it up in the picture. Can you please mark that lesion in the picture? Then I will be able to help in a better way. But now, I could not determine anything significant that needs to be worried about. I suggest consulting a specialist doctor and getting it examined.

Thank you.