The cutaneous manifestations of systemic diseases are diverse. In some
cases, they are the first signs of an underlying disorder, such as Co
wden's disease, dermatomyositis, and Lyme disease. Sister Mary Joseph'
s nodule (metastatic involvement of the umbilicus) is an ominous sign
of internal malignant disease. Drug-induced skin necrosis may result f
rom therapy with coumarin (Coumadin, Panwarfin, Sofarin) or heparin.