Primary Umbilical Endometriosis: Villar's Nodule.

Dear Editor,

With great deal of interest we read the article entitled “Umbilical Hernia as Forerunner of Primary Umbilical Endometriosis: A Case Report” by Hansadah et al.[1].

The pathogenesis of primary cutaneous endometriosis is still unknown with the umbilicus being the most common site. The pathogenetic pathways may include migration of endometrial tissue either lymphatic or vascular as well as cellular metaplasia and in the majority of the cases is stimulated by inflammation[2].

Regarding the differential diagnosis among others, keloid, Sister Mary Joseph nodule and melanoma should be highlighted[3]. We would also like to mention that dermoscopy might be a useful tool in the diagnostic pathway where the so called “red atolls” are characteristic irregular glands with embedded erythrocytes in a cellular stroma within this red coloured pigmentation[4].

As far as the surgical management apart from the complete excision, which is crucial for the prognosis, umbilical reconstruction might also be considered with the use of umbiliconeoplasty methods (with or without external scars or graft) or abdominal flaps e.g. Borges technique, L-V flap technique, modified unfolded cylinder technique[5].

Once again, we would like to thank the authors for their excellent study.