An 87-year-old woman presented with severe iron deficiency anaemia (haemoglobin 57 g/L). She also described a recent increase in the number of pigmented skin lesions on her trunk, which had become mildly pruritic. Her history included a right hemicolectomy 12 years earlier for tubulovillous adenoma and suspicion of malignant transformation. At that time, her serum carcinoembryonic antigen (CEA) had been normal and resection histology revealed complete margins with no evidence of malignancy. Unfortunately, she had declined colonoscopy surveillance following this.
On examination, she was found to have extensive seborrhoeic keratoses, which had recently increased in size and number (figure 1). Although the patient preferred to avoid colonoscopy, further investigations for an underlying malignancy were pursued. A CT scan of the abdomen showed suspicious bowel thickening suggestive of colorectal malignancy (figures 2 and 3) and a serum CEA was markedly elevated (167 µg/L). These findings...
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