An otherwise healthy 51-year-old man presented with a 20-year history of a slow growing indolent perianal mass and additionally, with recent intermittent perianal bleeding. Clinical examination revealed a large, cauliflower-like perianal tumour. Investigations showed a superficial tumour with no infiltration of the anal sphincters and proctoscopy ruled out additional tumour growth above the anal verge. A wide local en bloc tumour excision was undertaken with carbon-dioxide laser vaporisation of the tumour bed. The histological appearance was of a completely resected Buschke-Loewenstein tumour.