Spontaneous Cutaneous Endometriosis of the Umbilicus
In December 2012, a 31-year-old Caucasian woman presented to the dermatology outpatient clinic with a 1-month history of a persistent, raised lesion in the umbilicus. The patient had noted swelling and one episode of spontaneous frank bleeding from the lesion. There was no associated cyclical pain at the lesion site.\nAt the time of examination, a single firm 0.5-cm black-coloured papule was seen within the umbilicus at the 3 o'clock position. The lesion was tender to palpation with intact overlying skin. No discharge or underlying umbilical hernia was noted.\nThe patient had a history of 2 previous melanomas: the first in 2003 on the left abdomen and the second on the right buttock in 2006. Both tumours were excised with clear margins. There was no history of previous abdominal or laparoscopic procedures. She had no previous diagnosis of endometriosis and no catamenial complaints.\nGiven the anatomical location, a skin punch biopsy of the umbilical lesion was performed. During dermatology review, 1 month later, it was noted that 3 distinct skin-coloured papules had appeared next to the initial lesion (fig. ).\nHistological examination of the punch biopsy revealed a lesion in the superficial dermis comprising a single dilated glandular structure, surrounded by cellular endometrial-type stroma (fig. ). The gland was lined by a single layer of columnar cells, a few of which had apical cilia. The overlying epidermis was unremarkable. No malignancy was identified. A diagnosis of cutaneous endometriosis was determined.\nThe patient was referred for surgical excision of the umbilical papules. Subsequent gynaecological evaluation revealed a 3-year history of dysmenorrhoea. A provisional diagnosis of coexistent pelvic endometriosis was made. Abdominal and transvaginal ultrasonography were unremarkable. A diagnostic and therapeutic laparoscopic examination was advised if the patient remained unable to conceive over the following 6 months.