INTRODUCTION: Ano-rectal melanoma is an uncommon finding in patients complaining of rectal bleeding and/or anal mass often misinterpreted as a haemorroidal pile. CASE REPORT: A 55-years-old woman, complaining of rectal bleeding, frequent anal pain and anal mass suspected for haemorroidal thrombosis was referred for evaluation and possible treatment. A brown polypoid mass arising from the anal canal/lower rectum with a maximum diameter of 6 cm was diagnosed. The hystological examination of the neoplasm, transanally removed, revealed the presence of a polypoid melanoma partially involving the resection margin. Nor metastases nor limph-node involvement were found at the total-body CT scan and at a CT-PET. C-KIT examination was negative. Multidisciplinary evaluation recommended an abdominoperineal resection followed by an adjuvant chemotherapy as the only possible salvage treatment. To date the patient has refused it. DISCUSSION: The delay in the diagnosis of an anal melanoma is well-known, bringing frequently to treat advanced stages of the disease that to date has no clear guidelines for the treatment.