A 79-year-old black woman who was admitted to the hospital because of hypoxia and sepsis was noted to have skin lesions in the umbilical area. One month earlier, she had been evaluated for abdominal pain and frequent diarrhea. An abdominal computed tomographic scan showed a large hepatic mass, and the patient underwent a laparotomy. Intraoperative gross inspection revealed massive tumor infiltration in and around the liver. A biopsy specimen demonstrated metastatic adenocarcinoma consistent with a pancreaticobiliary origin. The patient was being considered for chemotherapy before this hospitalization. A dermatology consultation was requested because new umbilical lesions had developed within the past month. The lesions were asymptomatic but progressively enlarging.
Kim KH, Teebor S, Crandell CM, Glick SA. Umbilical Nodule in an Elderly Woman—Quiz Case. Arch Dermatol. 2003;139(11):1497-1502. doi:10.1001/archderm.139.11.1497-a