The clinician is grabbing the SMJN with the umbilicus just to its right. A cutaneous metastasis of small cell lung cancer may be seen below.
Sister Mary Joseph's nodules

Tumors metastatic to the umbilicus are called Sister Joseph's nodules. Periumbilical lymph nodes or cutaneous nodules may be present. Common origins for the tumor in men include the stomach, colon, pancreas, and small bowel. For women, the ovary, stomach, endometrium, breast, colon and pancreas are common sites of origin. There has been much debate as to whether Mary should be included in the name. Primary malignancies (e.g. SCC, adenocarcinoma and melanoma) and benign lesions (e.g. endometriosis, nevus, EIC, keloid, hernia, and pilonidal granulomata) should be considered in the differential diagnosis.


The malignancy should be found and treated. Prognosis is usually poor.


JAAD June 2015 Volume 72, Issue 6, Pages 1066–1073


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