Advanced-Stage Anal Squamous Cell Carcinoma Detected During Colonoscopy in a Rural HIV-Positive Patient: A Case Illustrating Fragmentation of Care and Barriers to Screening.

Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy with increasing incidence, particularly among people living with human immunodeficiency virus (HIV). In rural populations, limited access to specialized screening and fragmented care contribute to delayed diagnosis and advanced-stage presentation. A 58-year-old male patient with a 25-year history of HIV presented with one month of persistent rectal pain, intermittent bleeding, and mass sensation. Physical examination revealed a 5 × 6 cm ulcerated lesion near the anal margin. The patient reported inconsistent adherence to antiretroviral therapy due to transportation barriers and had no prior anorectal screening. Colonoscopy was performed, during which rectal retroflexion revealed an irregular, ulcerated, exophytic lesion with friability and infiltrative features. Biopsies and subsequent examination under anesthesia confirmed anal SCC. Staging demonstrated regional lymph node involvement without distant metastases, consistent with stage IIIA (T3N1M0). The patient was referred to colorectal surgery, radiation oncology, and medical oncology for further treatment. Ultimately, this case highlights how transportation barriers, inconsistent care access, and reliance on multiple geographically separated providers contributed to delayed diagnosis. In resource-limited settings, the lack of high-resolution anoscopy restricts early detection. Although not a primary screening tool, colonoscopy with careful anorectal evaluation may allow for opportunistic detection of malignancy in high-risk individuals. This case underscores the need for improved care integration and expanded access to screening resources among rural communities.