Beyond the surface: The primary care diagnostic challenge of Sister Mary Joseph nodule
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Che Nur Ain Che Abdullah 1 2 , Nani Draman 1 2 * , Noraini Mohamad 3 , Wan Noor Hasbee Wan Abdullah 4 , Ahmad Zuraimi Zulkifli 5 , Nur Hidayati Mohamad Pakarul Razy 6
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1 Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA2 Hospital Pakar Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA3 Medical and Basic Dental Sciences Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA4 Department of Dermatology, Hospital Raja Perempuan Zainab II, Kota Bahru, MALAYSIA5 Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, MALAYSIA6 Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, MALAYSIA* Corresponding Author

Abstract

Sister Mary Joseph nodule is a rare manifestation of metastatic umbilical malignancy, most commonly associated with gastrointestinal and genitourinary cancers. It often signifies advanced disease and carries a poor prognosis. Early recognition is critical, yet diagnostic delays may occur due to nonspecific presentations in primary care. We report a case of a 63-year-old Malay woman with a history of diabetes mellitus, hypertension, and hyperlipidemia, presented with an 8-month history of progressive umbilical skin growth, mild abdominal discomfort, and constitutional symptoms, such as loss of weight and loss of appetite over two months. Retrospectively, she noticed an erythematous nodular skin lesion over the umbilicus, which had slowly increased in size over the last 8 months. She visited health clinics four times, where the lesion was treated as eczema, and she was prescribed steroid creams. However, her symptoms persisted. One month before referral, she developed significant weight loss, prompting her doctor to refer her to a dermatology clinic for suspected skin cancer. We aim to enhance clinical awareness among primary care providers about recognizing and promptly treating the disease to prevent further deterioration.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Case Report

ELECTRON J GEN MED, Volume 23, Issue 2, April 2026, Article No: em727

https://doi.org/10.29333/ejgm/18283

Publication date: 31 Mar 2026

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