Violaceous Papules and Nodules Over the Umbilicus: The Harbinger of Occult Intra-Abdominal Malignancy

A 45‐year‐old woman was admitted to the surgery department for abdominal pain of 2 months duration and associated history of weight loss. Patient had undergone cholecystectomy and cesarean section in the past. A referral was sent for lesions over the umbilicus. There was no history of breathlessness, hemoptysis, or chest pain indicative of pulmonary malignancy. No history of nausea, vomiting, abdominal distension, constipation, diarrhoea, bloating, or per rectal bleeding (melena or hematochezia) was present suggesting gastrointestinal involvement. Also symptoms of urinary, genital, and ovarian malignancy were absent, except for the vague abdominal pain, reduced appetite, and weight loss which was of recent onset. Cutaneous examination revealed multiple lichenoid and few erythematous papules and nodules with rough surface and hard consistency, in and around the umbilicus and extending to cesarean section scar over the infra‐umbilical region [Figure 1]. Considering a diagnosis of warts but to rule out malignancy, a punch biopsy of the papule was done which revealed features of metastatic mucinous