[Sister Mary Joseph's nodule. Its clinical significance and management]

The eponym Sister (Mary) Joseph's nodule is referred to the existence of umbilical metastasis. Historically it has been considered a sign of ominous vital prognosis and therapeutic abstention. The analysis of 407 cases published at the medical literature (MEDLINE 1966-1997) is against this idea, because recent series have showed survivals longer than a year after treatment. On the other hand 60% of umbilical nodules are benign. Nowadays this sign must be considered as an early indicator of inner neoplasms, mainly from the abdominal cavity (52% digestive origin, 28% gynecologic origin), and in 40% of cases they are the only expression of relapse of previously known neoplasms. When a umbilical nodule is found it is necessary to make an accurate histologic differential diagnosis between a primary (benign or neoplastic) and metastatic lesions. Fine needle aspiration has demonstrated to be an easy and reliable method for diagnosis. Once the metastatic origin of the nodule is confirmed treatment with curative intention must be tried.