Cutaneous endometriosis: to scope or not to scope?

Background: Cutaneous endometriosis occurs in a surgical scar following abdominal or pelvic procedures. The incidence of scar endometriosis has been estimated to be only 0.03-0.15% of all cases of endometriosis. The tendency to use routine laparoscopic inspection of the pelvis to exclude concurrent pelvic endometriosis has been applied extensively over the years. Aim of the study: The aim of this study was to investigate if patients with cutaneous endometriosis should always undergo laparoscopy to exclude pelvic endometriosis. Material and methods The study included women presenting with a history of painful nodules at either the umbilicus, a midline incision or at the level of a Pfannenstiel scar, following gynecological or caesarean section procedures. The lesion may have been slightly tender around the time of menstruation. Bleeding from the umbilical or scar nodule during or after menstruation was also described by some patients. The study began in January 2010 and ended in December 2016. All patients underwent umbilical or scar nodule biopsy confirming the presence of endometriosis before the diagnostic laparoscopy took place. Results: Fourteen patients with cutaneous (scar) and umbilical endometriosis attended the clinic during the study period. Out of these, only eight cases (47.2%) met the inclusion criteria of scar endometriosis clinically and underwent diagnostic laparoscopy. The mean age was 35.6 years (29-47) and mean parity was 1.5 (0-3), with a history of previous pelvic surgery or caesarean sections. Biopsy of the lesion confirmed the presence of endometrial tissue (gland and stroma) and haemorrhage. Diagnostic laparoscopy, after the excision of umbilical or scar endometriosis, revealed no pelvic endometriosis. Conclusion: A laparoscopy to exclude pelvic endometriosis should not be undertaken in patients who present with scar endometriosis, as there is a potential risk of introducing endometriosis into the pelvic cavity.