IntroductionMetastasis to the umbilicus from intra-abdominal malignantsolid tumors is not common, occurring mostly in patientswith advanced gastrointestinal and gynecologic carcinomasalthough it may sometimes be the first presentation of anoccult, underlying adenocarcinoma [1–4]. This condition isalso known as Sister Mary Joseph's nodule or sign, namedafter Sister Mary Joseph (1856–1939), the superintendentnurse and surgical assistant of Dr. William Mayo at St.Mary's Hospital in Rochester, Minnesota, USA, who no-ticed the association between umbilical nodules observedduring skin preparation for surgery and advanced intra-abdominal cancer found at surgery [5, 6]. Her name wasaccredited to this clinical feature in 1949 by Sir HamiltonBailey in his book “Physical Signs in Clinical Surgery”.Pancreatic carcinoma usually metastasizes to regionallymph nodes, liver, and peritoneum. However, 10 % ofumbilical metastases originate from a pancreatic carcinoma[7, 8] and sometimes they are the first sign of the disease [9,10]. In this report, we present a patient who had a previouslymesh-repaired umbilical hernia and presented with a SisterMary Joseph's nodule associated with an advanced, meta-static adenocarcinoma of the pancreas before diagnosing theprimary tumor.Case ReportA 64-year-old woman was admitted because of painlessobstructive jaundice of 3-days duration when she noticedyellow-colored scleras and dark-colored urine. Threemonths before presentation she noticed a gradually enlarg-ing, progressively painful and inflamed skin nodule in theumbilicus. She also reported loss of appetite and a 10-kgweight loss over this time period. She had no history of liverdisease and she denied having fever, gastrointestinal com-plaints, or any systemic symptoms. Her past medical historyincluded an umbilical hernia repair by using a prostheticmesh 3 years before.On physical examination the scleras and the skinappeared yellow. An abdominal scar of a midline surgicalincision was present above and below the umbilicus. Awell-circumscribed reddish mass measuring approximately 2 cmin diameter, with a slightly ulcerated surface, hard, andpainful on palpation, and fixed to the underlying tissueswas noted in the umbilicus (Fig. 1). Abdominal examinationrevealed mild tenderness localized in the right upper abdom-inal quadrant and the epigastrium, but no mass was palpa-ble. There were no enlarged cervical, axillary, or inguinallymph nodes.