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Anorectal malignant melanoma (ARMM) is an extremely rare condition, often misdiagnosed and mistreated until development of metastatic disease. Clinical presentation mimicking hemorrhoids is a well-known pitfall. We present a male patient with hemorrhoidal nodules who was referred to the policlinic of dermatology for management of anal pruritus. A dark macule was detected over one of the hemorrhoidal nodules histologically verified as melanoma. Subsequent CT and PET/CT showed lymph nodes involvement and the patient underwent wide local excision (WSE) followed by abdominoperineal resection (APR). The rarity of ARMM does not allow for establishment of a validated staging system, placebo-controlled treatment trials and management guidelines adoption. The current treatment for the condition is surgical excision, using different techniques according to the stage of the disease and depth of invasion. The prognosis and overall survival are poor, but recent genetic studies give promising results for molecular targeting. Awareness for this disease is indispensable, as early recognition could result in improved survival and quality of life.

The anatomical structures of the rectum and anus are a functional unit designed to maintain continence mechanism. A pure anatomical description often fails to delineate this critical functional interaction. The topographic anatomy of the anorectum must be combined with an understanding of the mechanisms of anal continence and defecation, which can be transferred to clinical and especially surgical practice. The feedback-controlled reflex system of continence must be understood; it hinges on a complex interaction between the somatic and autonomic nervous systems.

Hemorrhoidectomy is not a simple procedure. Hemorrhoids develop as hyperplastic formations of an important part of the anorectal organ of continence, i.e., the corpus cavernosum recti. This organ segment is analogous to tissue structures found in the tongue of certain birds which are used for hulling seeds. Well-meaning, complete resection of the corpus cavernosum will inevitably result in incontinence. Only operative techniques which resect exclusively those segments of the hemorrhoidal tissue adjacent to the muscle layer in the anal canal are adequate. These procedures will spare sufficient tissue of the corpus cavernosum to allow a safe segmental resection of this structure and at the same time permanently eradicate the hemorrhoids. In the present paper, the treatment of 53 patients with postoperative incontinence and of others with stenoses, fistulas and pelvic infections is discussed. Fatalities have never been reported in the literature following operative hemorrhoidectomy, however, have occurred after "banding" procedures and after injection therapy.

Sigmoid diverticula are pseudodiverticula, protrusions of the mucosa between the muscularis, so that they pouch out ball shaped under the serosa or in the fatty connective tissue of the sigmoid region. They occur in pairs, often symmetrically along the taenias. They increase with age; as their evidence depends on the actual contraction of the bowel, the incidence varied strongly with the method of investigation. The pseudo-diverticula can cause diverticulitis. The anatomical characteristics of the large bowel are the fortified longitudinal muscular bands, the taenias, and the haustras. By a contraction and a permanent shortening of the taenias the normally "open" haustras become closed pressure chambers. The muscular coat and the mucosal coat differ very much in size, that the mucosa folds out to the outside. Of decisive importance is, that the muscular and mucosal coat are both fixed to each other by a sliding layer. The modern popular etiological theories can be fairly summarized under the point of view of the longitudinal shortening and the sliding layer.

The perianal region of 294 healthy persons (151 male, 143 female) of different age was examined and the size, the localization and the number of the skin tags were registered. The frequency increases in women especially at the beginning of the second decade and in men especially at the fourth decade of life. 80% of all women and 60% of all men have skin tags. The size of the skin tag increases while the person becomes older. In the average women have bigger skin tags than men. Most of the skin tags are located in the region of 12 and 6 h lithotomy position.

The newest investigations about the morphology and pathomorphology of the corpus cavernosum recti are given. The importance of the m. canalis ani and of the hitherto unknown transsphincteric course of the blood reflux from the arterially supplied corpus cavernosum for the pathogenesis of the hemorrhoidal disease as the adequate therapy are delineated.