Cutaneous endometriosis

Author: Brian Wu PhD. MD Candidate, Keck School of Medicine, Los Angeles, USA. Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, November 2015.

What is endometriosis?

The endometrium is the lining of the uterus (womb). Endometriosis is the growth of endometrial tissue outside the uterus. It usually arises close to the uterus within the pelvis—the lower part of the abdomen. The mass is also called an “endometrioma,”. Endometriosis outside the pelvis occurs in about 12% of women with endometriosis.

What is cutaneous endometriosis?

Cutaneous endometriosis is endometriosis in the skin, and is rare. It was first described by Villar in 1860. It commonly occurs in a surgical incision from a previous gynaecological or abdominal surgery, such as Caesarian section, hysterectomy or laparoscopic surgery. It also called “scar endometriosis”.

The most common sites for cutaneous endometriosis are the abdominal wall, the umbilicus and the extremities.

What causes cutaneous endometriosis?

Cutaneous endometriosis is most often caused by the implantation of endometrial cells in incisions during the course of surgery.

It can also develop spontaneously. There are two theories regarding the cause of spontaneous cutaneous endometriosis.

What are the clinical features of cutaneous endometriosis?

Women with cutaneous endometriosis can present with the following signs and symptoms.

What complications stem from cutaneous endometriosis?

Complications from cutaneous endometriosis include:

Malignancy should be suspected if the mass is abnormally large, has grown rapidly, or has recurred after previous excisions.

How is cutaneous endometriosis diagnosed?

Diagnosis of cutaneous endometriosis is based upon:

Histopathology is the key to accurate diagnosis and detects endometrial glands, stroma and haemosiderin, if present.

Diagnosis is often delayed due to confusion with other conditions, including haematoma, neuroma, hernia and neoplastic tissue.

What is the treatment for cutaneous endometriosis?

The main treatment for cutaneous endometriosis is surgical excision of the mass, preserving the umbilicus whenever possible and if relevant.

Medical therapy uses the hormones danazol, progesterone, and Gonadotrophin Releasing Hormone (GnRH).

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