Case and Research Letters
Dermoscopic Features of Sister Mary Joseph Nodule
Dermatoscopia del nódulo de la hermana María José
C. Garrido Colmenero
, G. Blasco Morente, I. Pérez López, J. Tercedor Sánchez
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Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Virgen de las Nieves, Granada, Spain
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Garrido Colmenero, G. Blasco Morente, I. Pérez López, J. Tercedor Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Garrido Colmenero" "email" => array:1 [ 0 => "cristinagarrido86@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Blasco Morente" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Pérez López" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatoscopia del nódulo de la hermana María José" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1327 "Ancho" => 995 "Tamanyo" => 232429 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, An erythematous nodule at the umbilicus. B, Dermoscopic examination showing a polymorphous vascular pattern. C, Positron emission tomography image showing a tumor mass at the hepatic angle of the colon with liver, umbilical, and peritoneal metastases.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermoscopy is a non-invasive diagnostic method that is used to evaluate morphological structures not visible to the human eye; dermoscopy thus helps us to differentiate and diagnose skin lesions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It is a useful tool that has enabled us to perform rapid in vivo study.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> There have been few publications on the use of dermoscopy for the diagnosis of skin metastases from malignant internal tumors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 67-year-old man who was seen for abdominal distension and an umbilical nodule that had appeared 6 months earlier. The patient reported constipation, abdominal pain, and weight loss of 5<span class="elsevierStyleHsp" style=""></span>kg in the previous month. On examination there was a firm, irregular, ulcerated erythematous nodule of 5<span class="elsevierStyleHsp" style=""></span>cm diameter at the umbilicus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The nodule contained serous fluid. Dermoscopy of the nodule with polarized light revealed white shiny structures and an atypical polymorphous vascular pattern with serpentine vessels and curved vessels with milky-red areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). This observation of polymorphous vessels and white shiny structures was suggestive of malignancy. Histopathology of the umbilical nodule revealed subcutaneous infiltration by a metastasis from an adenocarcinoma of the colon; the lesion was positive for cytokeratins CK7 and CK20 and CDX-2. Computed tomography and positron emission tomography showed a tumor mass at the hepatic angle of the colon, with liver, umbilical, and peritoneal metastases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Two liters of ascitic fluid were drained on paracentesis. Tumor resection was then considered, but the patient died before this could be performed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Sister Mary Joseph's nodule (SMJN) is an eponym for umbilical skin metastasis from a malignant tumor. It is a rare manifestation, but may be the only presenting sign of a primary malignant visceral tumor.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The correct diagnosis of SMJN is crucial as it occurs predominantly in advanced or metastatic tumors. Clinically it presents as a small, irregular nodule that can be painful and can ulcerate; it can sometimes contain pus, blood, or serous fluid. The clinical differential diagnosis of SMJN includes malignant and benign lesions such as pyogenic granuloma, epidermal cyst, hemangioma, abscess, umbilical hernia, endometriosis, and primary umbilical carcinoma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Dermoscopic examination will exclude pyogenic granuloma, basal cell carcinoma, and inflammatory conditions, as these would present other types of vessels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date, 3 reports have been published on the dermoscopic features of skin metastases from internal malignant tumors. De Giorgi et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> and Oiso et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> described atypical polymorphous vascular patterns in skin metastases from a recurrent thyroid carcinoma and in a skin metastasis from a possible occult breast cancer. But it was Mun et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> who first described the dermoscopic features of SMJN that had arisen from an adenocarcinoma of the pancreas. Recently, Chernoff et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> published an article in which they analyzed the vascular patterns of skin metastases; the most typical dermoscopic findings were serpentine vessels, linear irregular vessels, and unstructured homogeneous areas of pink color.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The dermoscopic vascular pattern is considered to be a pathognomic phenomenon of neovascularization related to neoplastic growth.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In the present case, dermoscopic examination of the umbilical lesion revealed a polymorphous vascular pattern that raised our suspicion of malignancy and led us to perform a skin biopsy that identified the presence of metastatic adenocarcinoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When an umbilical nodule is observed, a metastatic malignant tumor must be excluded as this may be its first clinical manifestation and indicates a poor prognosis. As far as we are aware, this is the second case report of the dermoscopic features of SMJN. The aim of this report is to increase the suspicion of a metastatic tumor when dermoscopic examination of an umbilical lesion reveals a polymorphous vascular pattern. Dermoscopy is now an essential additional tool for dermatologic diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garrido Colmenero C. Dermatoscopia del nódulo de la hermana María José. Actas Dermosifiliogr. 2015;106:511–512.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1327 "Ancho" => 995 "Tamanyo" => 232429 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, An erythematous nodule at the umbilicus. B, Dermoscopic examination showing a polymorphous vascular pattern. 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Myskowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.8502" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2014" "volumen" => "150" "paginaInicial" => "429" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24430974" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001341/v1_201506260207/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000006/v1_201506260207/S1578219015001341/v1_201506260207/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001341?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 8 | 14 |
| 2024 Octubre | 63 | 52 | 115 |
| 2024 Septiembre | 72 | 35 | 107 |
| 2024 Agosto | 106 | 64 | 170 |
| 2024 Julio | 72 | 41 | 113 |
| 2024 Junio | 100 | 30 | 130 |
| 2024 Mayo | 90 | 38 | 128 |
| 2024 Abril | 78 | 27 | 105 |
| 2024 Marzo | 82 | 44 | 126 |
| 2024 Febrero | 55 | 28 | 83 |
| 2024 Enero | 56 | 32 | 88 |
| 2023 Diciembre | 68 | 20 | 88 |
| 2023 Noviembre | 84 | 29 | 113 |
| 2023 Octubre | 69 | 22 | 91 |
| 2023 Septiembre | 77 | 35 | 112 |
| 2023 Agosto | 59 | 21 | 80 |
| 2023 Julio | 52 | 45 | 97 |
| 2023 Junio | 50 | 25 | 75 |
| 2023 Mayo | 41 | 30 | 71 |
| 2023 Abril | 42 | 26 | 68 |
| 2023 Marzo | 48 | 30 | 78 |
| 2023 Febrero | 40 | 25 | 65 |
| 2023 Enero | 59 | 26 | 85 |
| 2022 Diciembre | 60 | 46 | 106 |
| 2022 Noviembre | 22 | 39 | 61 |
| 2022 Octubre | 25 | 32 | 57 |
| 2022 Septiembre | 37 | 48 | 85 |
| 2022 Agosto | 27 | 36 | 63 |
| 2022 Julio | 29 | 47 | 76 |
| 2022 Junio | 28 | 29 | 57 |
| 2022 Mayo | 40 | 40 | 80 |
| 2022 Abril | 53 | 32 | 85 |
| 2022 Marzo | 54 | 46 | 100 |
| 2022 Febrero | 70 | 32 | 102 |
| 2022 Enero | 91 | 39 | 130 |
| 2021 Diciembre | 49 | 44 | 93 |
| 2021 Noviembre | 57 | 43 | 100 |
| 2021 Octubre | 73 | 54 | 127 |
| 2021 Septiembre | 92 | 37 | 129 |
| 2021 Agosto | 101 | 32 | 133 |
| 2021 Julio | 54 | 25 | 79 |
| 2021 Junio | 68 | 32 | 100 |
| 2021 Mayo | 63 | 34 | 97 |
| 2021 Abril | 140 | 42 | 182 |
| 2021 Marzo | 100 | 23 | 123 |
| 2021 Febrero | 80 | 21 | 101 |
| 2021 Enero | 52 | 20 | 72 |
| 2020 Diciembre | 57 | 28 | 85 |
| 2020 Noviembre | 26 | 16 | 42 |
| 2020 Octubre | 41 | 18 | 59 |
| 2020 Septiembre | 50 | 13 | 63 |
| 2020 Agosto | 28 | 23 | 51 |
| 2020 Julio | 41 | 13 | 54 |
| 2020 Junio | 46 | 31 | 77 |
| 2020 Mayo | 34 | 19 | 53 |
| 2020 Abril | 39 | 18 | 57 |
| 2020 Marzo | 36 | 14 | 50 |
| 2020 Febrero | 5 | 1 | 6 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 10 | 3 | 13 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Agosto | 5 | 5 | 10 |
| 2019 Julio | 8 | 13 | 21 |
| 2019 Junio | 4 | 13 | 17 |
| 2019 Mayo | 6 | 14 | 20 |
| 2019 Abril | 4 | 8 | 12 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 2 | 1 | 3 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 2 | 4 | 6 |
| 2018 Noviembre | 4 | 3 | 7 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 50 | 2 | 52 |
| 2018 Enero | 49 | 5 | 54 |
| 2017 Diciembre | 55 | 10 | 65 |
| 2017 Noviembre | 27 | 5 | 32 |
| 2017 Octubre | 28 | 8 | 36 |
| 2017 Septiembre | 21 | 13 | 34 |
| 2017 Agosto | 26 | 12 | 38 |
| 2017 Julio | 17 | 10 | 27 |
| 2017 Junio | 24 | 24 | 48 |
| 2017 Mayo | 37 | 18 | 55 |
| 2017 Abril | 17 | 6 | 23 |
| 2017 Marzo | 26 | 55 | 81 |
| 2017 Febrero | 18 | 7 | 25 |
| 2017 Enero | 17 | 13 | 30 |
| 2016 Diciembre | 31 | 9 | 40 |
| 2016 Noviembre | 26 | 11 | 37 |
| 2016 Octubre | 33 | 11 | 44 |
| 2016 Septiembre | 0 | 10 | 10 |
| 2016 Agosto | 0 | 7 | 7 |
| 2016 Julio | 4 | 2 | 6 |
| 2016 Junio | 4 | 3 | 7 |
| 2016 Mayo | 3 | 4 | 7 |
| 2016 Abril | 1 | 13 | 14 |
| 2016 Marzo | 4 | 7 | 11 |
| 2016 Febrero | 3 | 2 | 5 |
| 2016 Enero | 3 | 1 | 4 |
| 2015 Diciembre | 0 | 2 | 2 |
| 2015 Octubre | 0 | 2 | 2 |
| 2015 Agosto | 0 | 4 | 4 |
| 2015 Julio | 0 | 3 | 3 |
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