A 74-Year-Old Caucasian Man Presents With Asymptomatic Navel “Lump”

A 74-year-old, previously healthy, nonsmoking Caucasian male presented with a 4-month history of an asymptomatic “lump” in the navel. Review of systems revealed an involuntary 17-pound weight loss during the previous 6 months and intermittent localized abdominal pain of mild to moderate severity. Recent routine laboratory values and chest radiograph were within normal limits. A carcinoembryonic antigen (CEA) level was 55 ng/mL (severely elevated). A fecal occult blood test was positive. Physical examination disclosed a firm 3.5 cm × 3 cm violaceous nodule occupying the central umbilicus, surrounded by a narrow rim of similarly colored, indurated periumbilical skin. Biopsy of the umbilical nodule revealed adenocarcinoma.