A 61 years old male patient presented to the AE Department reporting bleeding during defecation. difficulty and low pain while walking and sitting. On physical examination we saw an exophytic cauliflower like. ulcerated tumor mass measuring 20 x 14 cm that covered the whole perineum and a similar satellite lesion 3 x 4 cm. https://www.roneverhart.com/POISON-OPEN-UP-AND-SAY-AHH-T-SHIRT/