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Off-Center Fold
November 2003

Umbilical Nodule in an Elderly Woman—Diagnosis

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Arch Dermatol. 2003;139(11):1497-1502. doi:10.1001/archderm.139.11.1497-a

A skin biopsy specimen from a nodule demonstrated a proliferation of enlarged and atypical epithelioid cells arranged in confluent nests and cords throughout the dermis. The results of immunohistochemical staining with mucicarmine were positive. These findings were diagnostic of adenocarcinoma of gastrointestinal origin.

In light of the patient's history and biopsy findings, it was determined that the umbilical lesions were consistent with metastatic adenocarcinoma of pancreaticobiliary origin. A subsequent abdominal computed tomographic scan showed multiple hepatic and peritoneal masses, biliary tract dilatation, and ascites. Because of the widespread nature of the malignancy, the patient was not a candidate for chemotherapy. She was discharged home and died 3 months later.

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