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noma (ACSCC) is quite rare, it can be recognized clearly using iodine staining [1]. Early-stage esophageal squamous cell carcinoma (SCC) has recently been diagnosed using both narrow-band imaging (NBI) [2] and autofluorescence imaging (AFI) [3]. Here we report on the first case of earlystage ACSCC diagnosed by NBI and AFI and treated successfully by endoscopic submucosal dissection (ESD). A 70-year-old woman was referred to our hospital for treatment of ACSCC. Conventional colonoscopy (PCF-Q240Z, Olympus Optical Co., Tokyo, Japan) revealed a slightly protruded lesion approximately 10mm in size and located close to the dentate line (●" Fig. 1). The superficial microvessels of the lesion were examined by white light and NBI systems with magnification (●" Fig. 2), and appeared similar to esophageal intraepithelial papillary capillary loops (IPCLs) [4]. The AFI image was purple in color (●" Fig. 3d), and the lesionwas unstained following iodine staining. NBI, AFI, and iodine staining images were similar to those of esophageal SCC (●" Fig. 3) [3,4]. An endoscopic diagnosis of carcinoma in situwasmade because of the IPCL-likemicrovessels; ESD was performed (●" Fig. 4) [5] because the location of the lesion caused technical difficulties in achieving an en-bloc endoscopic mucosal resection. Histopathological analysis of the resected specimen revealed SCC, with microinvasion of 0.4mm but no lymphovascular invasion (●" Fig. 5). Chemoradiation therapy, with a dose-reduction of 25%, was carried out because of the microinvasion. A follow-up colonoscopy performed 23 months later revealed the ESD scar (●" Fig. 6), and the biopsy specimen was negative for malignancy. Endoscopic diagnosis of ACSCC and an accurate prediction of invasion were both based on similarity to esophageal IPCLs. En-bloc ESD of early-stage ACSCC followed by chemoradiation therapy resulted in a successful treatment and better patient quality of life; it is possible, therefore, that this could become a standard treatment protocol in the future for earlystage ACSCC. Endoscopy_UCTN_Code_TTT_1AQ_2AD Novel diagnostic methods for early-stage squamous cell carcinoma of the anal canal successfully resected by endoscopic submucosal dissection