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A flat depressed early colon cancer (FDEC) is characterized by non-polypoid
growth pattern, no association of adenomatous tissues and a tendency of even
small lesions toward submucosal invasion and lymph node metastasis. It supports
de novo carcinogenesis of colorectal cancer, although most colorectal cancers
arise in pre-existing adenoma (adenoma-carcinoma sequence). There have been few
reports of small depressed cancers because of the difficulty in colonoscopic
detection and the rapid development to ulcerating advanced cancers. We report a
case of flat depressed early colon cancer confined to mucosa detected by indigo
carmine contrast colonoscopy.