An 87-year-old woman presented with severe iron deficiency anaemia (haemoglobin 57 g/L). She also described a recent increase in the number of pigmented skin lesions on her trunk, which had become mildly pruritic. Her history included a right hemicolectomy 12 years earlier for tubulovillous adenoma and suspicion of malignant transformation. At that time, her serum carcinoembryonic antigen (CEA) had been normal and resection histology revealed complete margins with no evidence of malignancy. Unfortunately, she had declined colonoscopy surveillance following this.