{"paper_id":"ee13a8d2-b488-4a71-873a-55d0d440f0c5","body_text":"Our Dermatology Online\n© Our Dermatol Online e.2024 1\nA multilobulated nodule of a cesarean section A multilobulated nodule of a cesarean section \nscar: Th ink of cutaneous endometriosisscar: Th ink of cutaneous endometriosis\nKenza Tahri Joutei Hassani, Zakia Douhi, Chaymae Bouhamdi, Hanane Baybay, \nSara Elloudi, Meryem Soughi, Fatima Zahra Mernissi\nDepartment of Dermatology, University Hospital Hassan II, Fes, Morocco\nCorresponding author: Kenza Tahri Joutei Hassani, MD, E-mail: kenzatahri10@gmail.com \nSir,\nWe report the case of a 35-year-old woman who presented \nwith a painful lower abdominal multilobular nodule \nand skin discolorations around the abdominal incision \nsite, two years after undergoing a cesarean section. The \npatient reported cyclic pain and volume augmentation \nof the nodule accompanied by red-colored fluid \ndischarge from the incision site. Upon examination, \na non-mobile, painful multilobular moderately \npigmented nodule, measuring approximately 2×3 cm, \nwas observed at the left lateral border of the incision \n(Fig, 1a). Dermoscopy revealed reddish areas separated \nby fibrous septa (Fig. 1b). Color Doppler ultrasound \nevaluation detected an irregular hypoechoic solid mass \nwith internal vascularity, measuring 2x1.3x2.2 cm. \nExcision of the nodule confirmed the diagnosis \nof cutaneous endometriosis, and the patient was \nreferred to gynecology for further evaluation of pelvic \nendometriosis.\nCutaneous endometriosis, a rare manifestation of \nendometriosis, is divided into primary and secondary \nforms, with the former resulting from spontaneous \nchanges in specific tissues under unknown factors, \nand the latter caused by iatrogenic factors [1]. The \nincidence of secondary cutaneous endometriosis is \nabout 3.5% in patients who undergo gynecological \nsurgery and about 0.8% in women with a previous \ncesarean section [2]. Scar endometriosis, a type of \nsecondary cutaneous endometriosis, is a rare condition \nthat accounts for 0.03% to 0.15% of all cases of \nendometriosis in gynecological literature. Due to its \nvaried presentation, such as pain, discoloration, and \nswelling around a Pfannenstiel skin incision, scar \nendometriosis often leads to a deferred diagnosis and \nunnecessary referrals. It can be mistaken for other \nconditions such as infections, abscesses, keloids, \ntumors, and lymphadenopathy [3].\n    This case highlights the challenges in diagnosing \ncutaneous endometriosis and emphasizes the \nimportance of considering this condition in the \ndifferential diagnosis of abdominal wall lesions \nfollowing cesarean sections. It also underscores the \nsignificance of timely excision as an effective treatment \nmodality.\nConsent\nThe examination of the patient was conducted according to the \nprinciples of the Declaration of Helsinki.\nCase Letter\nHow to cite this article: Tahri Joutei Hassani K, Douhi Z, Bouhamdi C, Baybay H, Elloudi S, Soughi M, Mernissi FZ. A multilobulated nodule of a cesarean section \nscar: Think of cutaneous endometriosis. Our Dermatol Online. 2024;15(e):e8.\nSubmission: 09.05.2023; Acceptance: 29.11.2023\nDOI: 10.7241/ourd.2024e.8\nFigure 1: (a) Multilobular moderately pigmented nodule at the cesarean \nsection scar. (b) Dermoscopy showing reddish areas separated by \nfi brous septa.\nba\n\nwww.odermatol.com\n© Our Dermatol Online e.2024 2\nREFERENCES\n1. Raffi L, Suresh R, McCalmont TH, Twigg AR. Cutaneous \nendometriosis. Int J Women Dermatol. 2019;5:384-6.\n2. Nominato NS, Prates LF, Lauar I, Morais J, Maia L,\nGeber S. Caesarean section greatly increases risk of  scar \nendometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152:\n83-5.\n3. Gonzalez RH, Singh MS, Hamza SA. Cutaneous endometriosis: a \ncase report and review of  the literature. Am J Case Rep. 2021;22:\ne932493.\nCopyright by Kenza Tahri Joutei Hassani, et al. This is an open-access \narticle distributed under the terms of the Creative Commons Attribution \nLicense, which permits unrestricted use, distribution, and reproduction in \nany medium, provided the original author and source are credited.\nSource of Support: This article has no funding source.\nConfl ict of Interest: The authors have no confl  ict of interest to declare.","source_license":"CC0","license_restricted":false}