Abstract
Cutaneous endometriosis (CEM) is a rare disease characterized by endometrial glands and/or stroma in the skin. Lesions present as a firm papule or nodule and can be blue, violaceous, red, brown or skin-colored. Patients frequently report cyclical tenderness, swelling and bleeding at the site of the lesion related to their menstrual cycle. CEM presents a diagnostic challenge as lesions are commonly mistaken for a keloid, dermatofibroma, dermatofibrosarcoma protuberans, melanoma or cutaneous metastasis of cancer (e.g., Sister Mary Joseph nodule). A biopsy must be taken to rule out malignancy and treatments include surgical excision and hormonal agents. To our knowledge, just over 100 cases have been reported in the literature. Herein we highlight a case of CEM in a 43-year-old female that presented to dermatology after being overlooked on prior work-up with obstetrics and gynecology. This case highlights the need for dermatologists to be familiar with CEM, as we may be the first clinicians these patients present to for painful cutaneous lesions.
Highlights
Cutaneous endometriosis (CEM) is defined as the presence of endometrial glands and/or stroma in the dermis or subcutis.[1,2]CEM primarily affects women of reproductive age and represents 0.5-1% of all ectopic endometriosis.[2,3] CEM can be classified as primary or secondary, with primary CEM accounting for less than 30%of all cases.[1]
She reported that the lesion was more painful with menstruation and occasionally bled. She reported a distant surgical history of cesarean section, laparoscopic appendectomy, and umbilical repair. She was evaluated by obstetrics and gynecology for pelvic pain two months prior, and was diagnosed with pelvic endometriosis; the umbilical nodule was not evaluated at that time
As studies have shown that 14% of women with CEM in gynecological scars have associated pelvic endometriosis,[4] a majority of patients with CEM may present with cutaneous manifestations alone
Summary
Cutaneous endometriosis (CEM) is defined as the presence of endometrial glands and/or stroma in the dermis or subcutis.[1,2]. A 43-year-old female presented with a bluish, 1.5 cm fluctuant and tender nodule on the umbilicus that had been present for approximately six months (Figure 1) Upon further questioning, she reported that the lesion was more painful with menstruation and occasionally bled. She reported that the lesion was more painful with menstruation and occasionally bled She reported a distant surgical history of cesarean section, laparoscopic appendectomy, and umbilical repair. She was evaluated by obstetrics and gynecology for pelvic pain two months prior, and was diagnosed with pelvic endometriosis; the umbilical nodule was not evaluated at that time. The patient was referred to obstetrics and gynecology for surgical excision
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