when there is inflammation of the umbilical cord, usually due to infection, which also delays cordseparation.Umbilical granuloma is most often detected after the cord has separated because of persistentdrainage of serous or serosanguineous fluid, or moisture around the umbilicus.The most common treatment for umbilical granuloma is topical 75% silver nitrate, usually appliedby a wooden applicator with premounted silver nitrate. The lesion is treated once or twice a weekfor several weeks, but generally only a few applications are required for successful treatment.Caution should be exercised in applying silver nitrate because it can cause chemical burns orstaining of the surrounding skin.Although data are limited, topical clobetasol propionate cream has been reported to besuccessful in treating umbilical granulomas [51]. However, there are concerns regarding thisintervention because of frequent adverse effects (skin atrophy and hypopigmentation), treatmentfailure, and the potential for systemic absorption. As a result, we would not routinely use topicalclobetasol propionate until further studies have shown that it is effective and safe [52].In cases that fail to respond to topical silver nitrate, ligation of the granulation tissue can beperformed in the office without discomfort [53]. Before ligation, the umbilicus should be carefullyexamined to rule out other causes of umbilical masses, such as umbilical polyp. Failure of thegranuloma to resolve with ligation and/or silver nitrate should also increase the suspicion that thelesion is actually an umbilical polyp.Umbilical polyp — Umbilical polyps are firm masses comprised of intestinal epithelium oruroepithelium, which are omphalomesenteric or urachal embryologic remnants [54,55]. Umbilicalpolyps, although they resemble a granuloma, are much less common, are often larger thangranulomas, and do not respond to silver nitrate therapy. These lesions require surgical excision.Ectopic tissue — Ectopic tissue in the umbilical cord is a very rare lesion that presents as asolid mass. Ectopic tissue can include pancreas, which most likely arises from growth ofpluripotent cells derived from the omphalomesenteric duct [39,56], or liver, which results frommechanical entrapment as the umbilical ring closes [39,57]. Surgical excision is required forremoval of ectopic tissue in the umbilicus.Older children and adults — Umbilical masses in older children and adults are uncommon.Both benign and malignant umbilical tumors have been reported [39].Benign lesions include hamartomas, pyogenic granulomas, nevi, inclusion cysts,hemangiomas, dermatofibromas, neurofibromas, granular cell tumors, desmoid tumors, andlipomas.●Primary malignancies are rare and include melanoma, urachal adenocarcinoma, squamouscell carcinoma, and basal cell carcinoma.●9 of 31 pages