The Convergence of Surgery, Skin and Cyclical Pain: A Diagnostic Puzzle

Scar endometriosis remains a clinical masquerader that requires a high index of suspicion in reproductive aged women with surgical histories. Here, we present a case of a 39-year-old female with complaints of tender nodular swelling over cesarean scar site. There was a triad of localized mass, previous uterine surgery, and distinct cyclical pain coinciding with menstruation. Dermoscopic evaluation revealed white polypoidal projections with central violaceous pigmentation and internal hemorrhagic spots. Wide surgical excision was performed, and histopathology confirmed the presence of endometrial glands. This case underscores the importance of recognizing cyclical pain, scar-related tender nodules in women with prior cesarean sections and role of dermoscopy in diagnosing scar endometriosis.