Necrolytic migratory erythema (NME) is mostly associated with a pancreatic-A-cell-glucagonoma and is considered to be a well-defined cutaneous paraneoplastic syndrome. We report on a 74-year old female who atypically developed a NME after surgical treatment of a rectal adenocarcinoma. Continuous staging and laboratory investigation over four years gave no evidence of any metastasis or further neoplasia.