10.5826/dpc.1201a23
text/xml
2160-9381
1748
en
Ricardo Ruiz-Villaverde
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermoscopy
Umbilical Endometriosis: A New Dermoscopic Pattern
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-04-03
2022-02-02
2022-02-09
e2022023
Dermatol Pract Concept
Ricardo Ruiz-Villaverde
2022/02/02
10.5826/dpc.1201a23
e2022023
Dermatology Department, Hospital Universitario San Cecilio, Granada, Spain
2160-9381
dermoscopy
en
e2022023
Sandoval M, Meza-Romero R, Peñailillo A, Villaseca MÁ, Navarrete-Dechent C. Dermoscopy findings of umbilical endometriosis. Australas J Dermatol. 2021;62(1):e139-e141. DOI: 10.1111/ajd.13437. PMID: 32909620.
Umbilical Endometriosis: A New Dermoscopic Pattern
https://dpcj.org/index.php/dpc/article/download/1748/1501
         Umbilical Endometriosis: A New Dermoscopic
                          Pattern
          Jorge Juan Vega-Castillo1, Soledad Saenz-Guirado1, Maria Luisa Vega-Castillo2,
                                      Ricardo Ruiz-Villaverde1


1 Dermatology Department, Hospital Universitario San Cecilio, Granada, Spain
2 Ophtalmology Department, Hospital de Alta Resolución de Écija, Spain



Key words: endometriosis, pattern, dermoscopy
Citation: Vega-Castillo JJ, Saenz-Guirado S, Vega-Castillo M, Ruiz-Villaverde R. Umbilical endometriosis: a new dermoscopic pattern.
Dermatol Pract Concept. 2022;12(1):e2022023. DOI: https://doi.org/10.5826/dpc.1201a23
Accepted: June 10, 2021; Published: January 2022
Copyright: ©2022 Vega-Castillo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original
authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Ricardo Ruiz-Villaverde, Unidad de Dermatología. Hospital Universitario San Cecilio, Granada, Spain.
E-mail: ismenios2005@gmail.com




Introduction                                                             appeared on a previous scar. Any recent bleeding episode
                                                                         was ruled out. A complete medical history revealed long-
Endometriosis is defined as the growth of ectopic endometrial            term dysmenorrhea as the only relevant clinical finding. On
tissue outside the uterine cavity. Extra pelvic endometriosis            dermoscopy, a central white reticular pattern on a violet
occurs in 12% of women, and umbilical endometriosis, a                   background was observed (Figure 1A). No vascular struc-
rare presentation of extra pelvic endometriosis, occurs in               tures, points, globules, or structures suggestive of a melano-
0.5%-1% of reported cases. Umbilical endometriosis is also               cytic lesion were observed. Histopathological examination
known as Villar nodule as Villar first described the condition           was consistent with cutaneous endometriosis (Figure 1B).
in 1886. Cutaneous endometriosis tends to settle on scars                Complementary tests, including abdominal-pelvic CT and
from surgical procedures (abdominal or pelvic surgery) such              determination of cancer antigen 125 offered results within
as h
   ­ ysterectomy, caesarean section, laparoscopy, or e­ pisiotomy.       normal ranges.
From a clinical point of view, it is necessary to establish a
differential diagnosis with amelanotic melanoma, basal cell
                                                                         Conclusions
­carcinoma, Sister Mary Joseph nodule, or pyogenic granuloma.
                                                                         There are few dermoscopic descriptions in the literature of
                                                                         cutaneous endometriosis [1,2]. The main dermoscopic find-
Case Presentation
                                                                         ings and histopathological correlation are reflected in Table 1.
A 45-year-old woman attended our dermatologic ­outpatient                There appears to be a difference in patterns depending on the
clinic complaining of a 4-months history of a solitary painless          phase of the hormonal cycle, as well as the depth of the lesion,
umbilical nodule. The bluish-green colored lesion had not                histological subtype and phototype of the patient.



Research Letter | Dermatol Pract Concept. 2022;12(1):e2022023                                                                          1
    Figure 1. (A) Polarized dermoscopy shows central white reticular pattern (blue arrow) on a violet background (blue star) (DermLite
    DL4, ×10). (B) Histopathology shows positivity for progesterone-receptor markers in endometrial glands and stroma (immunohis-
    tochemistry: anti-progesterone receptor antibodies; original magnification, ×100).



                         Table 1. Dermoscopic Descriptions of Umbilical Endometriosis
    Authors      Dermatoscope Model                  Dermoscopic Features                   Interpretation          Polarized Mode
 De Giorgi,     Heine-10                      Homogeneous reddish                       Multiple irregular        Non-polarized
 2003 [3]                                     pigmentation, regularly                   glands with
                                              distributed, gradually fading to          erythrocytes in a
                                              the periphery Small red globular          myxoid vascular
                                              structures (red atolls)                   stroma
 Jerez-Jaime, DermLite II Pro HR              Homogeneous reddish                       Myxoid vascular           Polarized light
 2013 [4]                                     localized pigmentation, with              stroma                    dermoscopy
                                              no differentiated structures
                                              Amorphous brown area with
                                              normal skin network
 Costa,         DermLite DL3,                 Polypoid projections of                   Endometrial atrophy       Polarized light
 2014 [5]                                     erythematous violaceous color,            Hemoglobin                dermoscopy
                                              area with dark brown globules             degradation after
                                              and area of active bleeding (mid          bleeding period,
                                              follicular phase) Increased in both       corresponding to
                                              characteristics (luteal phase)            hemosiderin deposits
 Bonné,         DermLite DL4                  Umbilical endometriosis (polypoid         Multiple irregular        Polarized light
 2020 [2]                                     structure) with drainage openings         glands with               dermoscopy
                                                                                        erythrocytes and
                                                                                        drainage openings
 Sandoval,      Unknown                       Pink homogeneous lesion with a            Hemosiderin               Polarized light
 2021 [6]                                     focal bluish blotch/clod                  deposits                  dermoscopy


    White reticular pattern (negative pigment network) is due          Informed consent: Informed consent for publication of clini-
to elongated rete ridges and is characteristic of melanoma.            cal details and clinical images was obtained from the patient.
Nevertheless, it has also been observed in Spitz/Reed nevi. The
diffuse area of bluish color is likely related to hemosiderin
deposits, unlike the referred deposits observed in other cases
                                                                       References
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                                                                        2. Bonné E, Daxhelet M, Simon P, Del Marmol V, Suppa M. The pe-
umbilical tumors are malignant. The description of new der-                culiar dermoscopic features of primary umbilical endometriosis.
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helpful in the diagnosis of this entity.                                   10.1111/jdv.16455. PMID: 32277548.



2                                                                          Research Letter | Dermatol Pract Concept. 2022;12(1):e2022023
 3. De Giorgi V, Massi D, Mannone F, Stante M, Carli P. Cutane-        5. Costa IM, Gomes CM, Morais OO, Costa MC, Abraham LS,
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                                                                                                                                ­ ermatol.
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 4. Jaime TJ, Jaime TJ, Ormiga P, Leal F, Nogueira OM, Rodrigues          PMID: 23621541
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    s0365-05962013000100019. PMID: 23539017; PMCID:                       ­endometriosis. Australas J Dermatol. 2021;62(1):e139-e141.
    PMC3699952.                                                            DOI: 10.1111/ajd.13437. PMID: 32909620.




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022023                                                                           3
