The Rusty Ring Sign Streamlining Flat Lesion Detection in Subtle Melanosis Coli

A 59-year-old man with regular on-demand laxative use underwent a screening colonoscopy (EC-760R-V/I; Fujinon, Düsseldorf, Germany). The entire mucosa was noted for speckled fine brown pigment spots consistent with discrete melanosis coli. In the descending colon, there was a brownish ring structure that was noticeable in the first instance, encircling a flat depigmented patch lesion (Paris 0–IIa) estimated at 3 mm (Figure A). Linked color imaging likewise highlighted the avascular nature of the lesion and indicated a fine granular mucosal surface pattern (Figure B).

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