Perianal Abscess with Fistula in Ano Complicating a s Basal Cell Carcinoma - A Rare Presentation

Introduction : Fistula in ano usually presents with pus discharge Perianal region, sometimes with mucus discharge. Malignant transformation in fistula in Ano very rare presentation1, and to assess preoperatively is almost next to impossible, it requires a high index of clinical suspicion and proper workup. Case R eport : We prese nt a very rare case of elderly female who initially presented with pus discharge and pain in Perianal region for 2 - 3 months, on through clinical examination and investigation (including MRI Fistulogram) done, a diagnosis of Perianal abscess and a high fist ula in Ano was made. Fistulous tract which was sent for histopathological examination turned out as Nodular type of Basal Cell Carcinoma Conclusion : Fistula in Ano is a benign disease usually present with pus discharge, with very rarely as malignant changes, a high index of suspicion should be kept if presenting in old age, with long standing history or with recurrent history or with history of mucus discharge or wi th some associated mass.