A 31-year-old woman, P2L2 delivered by two lower segment caesarean sections, presents with a firm, tender 2 cm nodule in the suprapubic scar that becomes markedly painful during each menstrual period. Excision biopsy is planned. What is the standard definitive management?
- A Continuous combined oral contraceptive pills indefinitely
- B Wide local excision of the nodule with clear margins ✓
- C Six cycles of GnRH agonist therapy
- D Local injection of triamcinolone into the nodule
Correct answer: B. Wide local excision of the nodule with clear margins
Explanation
Scar (cutaneous) endometriosis follows iatrogenic implantation of endometrium during caesarean section and presents as a cyclically painful, enlarging scar nodule. It is hormone-resistant relative to pelvic disease and carries a small risk of malignant transformation, so complete wide surgical excision with histology is the treatment of choice. Medical suppression only temporises symptoms and recurrence follows once therapy stops.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.