Carc inoma of the ga l lb ladder is an u n c o m m o n mal ignancy t h a t ha s a s t rong associa t ion wi th cholelithiasis. 1 The major i ty of pa t i en t s wi th ga l lb ladder cancer p re sen t wi th s y m p t o m s caused by advanced, incurable disease. 2, 3 Pa t i en t s wi th ear ly and potent ial ly cura t ive t u m o r s a re usua l ly discovered to have ga l lb ladder cancer incidenta l ly a f te r cholecys tec tomy for s y m p t o m a t i c cholelithiasis. 4, 5 Nonopera t ive techniques for t r e a t i ng symptoma t i c gal ls tones a re safe and effective a l t e rna t ives to cholecys tec tomy in those who are poor opera t ive r isks and in pa t i en t s who wish to avoid genera l anes the s i a or the loss of t he i r gal lbladder . 6-9 A cri t ic ism of nonopera t ive t r e a t m e n t s is t h a t t he re will be a smal l n u m b e r of pa t i en t s wi th early, unsuspec t ed ga l lb ladder cancer who will not have potent ia l ly cura t ive t r e a t m e n t of th is ma l ignancy by cholecystectomy. We rou t ine ly pe r fo rm pe rcu taneous cholecystoscopy in pa t i en t s t r e a t ed for s y m p t o m a t i c cholel i thiasis wi th percu ta neous contact dissolut ion or stone extract ion. 7, 10, 11 Pe rcu taneous cholecystoscopy is ut i l ized to ensu re t h a t all ga l ls tones and debris have been to ta l ly removed and to eva lua te the ga l lb ladder mucosa for inc idental t u m o r s or ulcers. In th is repor t we p re sen t a pa t i en t who was found to have an o therwise unsus pected ear ly ca rc inoma of the ga l lb ladder by cholecystoscopy following pe rcu t aneous topical gal ls tone dissolution.