The case of a 65 year old patient with ulcerative colitis is reported, who
had a dysplasia-associated lesion or mass (DALM) in her rectum. Refusing su
rgery after detection of the lesion and on follow-up, she underwent surgery
only 18 years later when frank carcinoma (Dukes C) was detected. Even if D
ALM may take a variable course, surgical excision is still highly recommend
ed.