Umbilical endometriosis: report of a case and its dermoscopic features*

Abstract

Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosis cases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.

Sister Mary Joseph's nodule: Malignant transformation of umbilical endometriosis

“…Endometriosis manifests as an umbilical nodule in less than 1% of all endometriosis cases. 1,2 Malignant transformation is a rare complication of endometriosis and is estimated to occur in 0.6-0.8% of women with ovarian endometriosis. 3 Additionally, there has been only a single report of an adenocarcinoma arising from umbilical endometriosis.…”

New findings in non‐invasive imaging of cutaneous endometriosis: Dermoscopy, high‐frequency ultrasound and reflectance confocal microscopy

“…Given a considerable variability in clinical (ie, body site, depth of localization, patient phototype), and histopathological appearance (ie, different phase of menstrual cycle, different histological subtype) and no standardized dermoscopical features. CE diagnosis can be sometimes challenging . Beside and patient's phototype, lesion morphology depends on and depth and on the phase of menstrual cycle.…”

“…Beside and patient's phototype, lesion morphology depends on and depth and on the phase of menstrual cycle. Moreover, when clinical history is not suggestive (ie, absence of cutaneous bleeding) and/or clinical presentation is not typical, some differential diagnoses should be considered, including vascular tumours, amelanotic melanoma and umbilical metastasis . Dermoscopic appearance of luteal phase umbilical was first described as “red atolls” within an homogeneous reddish background, or as “reddish homogeneous pigmentation.” Costa et al.…”

“…The typical clinical presentation of CE is a nodular mass with variable colour (erythematous, brownish or purplish) and with increasing volume, sometimes with pain and bleeding during menstrual cycle . To date, CE dermoscopic features have been described in only 3 cases referring to primary and not pigmented umbilical lesions . Moreover, there are no descriptions of CE under in vivo or ex vivo reflectance confocal microscopy (RCM) and high‐frequency ultrasound (HFUS).…”

Primary cutaneous endometriosis of umbilicus

“…Less than 30% of cutaneous endometriosis presents without prior surgical operative history, which is termed as primary spontaneous cutaneous endometriosis 3 . Umbilical endometriosis is composed 0.4% to 4.0% of all endometriosis, high as two-fifths of extragenital endometrioric lesions.…”