From the Guidelines
The presence of Leser-Trélat sign, characterized by the sudden onset of multiple seborrheic keratoses, is a significant indicator of internal malignancy, particularly gastrointestinal adenocarcinomas, and warrants thorough cancer screening and investigation. The Leser-Trélat sign is a rare paraneoplastic condition that has been associated with various internal cancers, including lymphomas, leukemias, and other malignancies 1.
Key Points to Consider
- The sudden appearance and rapid increase in size and number of seborrheic keratoses can serve as a cutaneous marker for an underlying cancer.
- Management involves identifying and treating the underlying malignancy, which may lead to regression of the skin lesions.
- Patients presenting with a sudden onset of multiple seborrheic keratoses should undergo thorough cancer screening, including comprehensive physical examination, laboratory tests, and appropriate imaging studies based on symptoms and risk factors.
- The exact mechanism behind Leser-Trélat syndrome is not fully understood, but it's believed to involve tumor-secreted growth factors like epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-α) that stimulate keratinocyte proliferation.
Clinical Implications
- Early recognition of this dermatological sign can lead to earlier cancer detection and potentially improved outcomes.
- A high index of suspicion for internal malignancy is necessary when encountering patients with Leser-Trélat sign, and a thorough diagnostic workup should be initiated promptly.
- The association between Leser-Trélat sign and internal malignancy highlights the importance of interdisciplinary collaboration between dermatologists, oncologists, and other healthcare professionals in the management of these patients.
From the Research
Leser-Trélat Sign and Internal Malignancy
The Leser-Trélat sign is a rare paraneoplastic cutaneous marker of internal malignancy characterized by the sudden eruption of multiple seborrheic keratoses (SK) 2. This sign is mostly associated with gastrointestinal adenocarcinomas, such as gastric, colon, and rectal cancer, and less frequently with breast cancer and lymphoproliferative disorders/lymphoma 2. It can also be associated with lung, kidney, liver, and pancreas malignancy 2.
Associated Cancers
- Gastrointestinal adenocarcinomas (gastric, colon, rectal) 2, 3
- Breast cancer 2
- Lymphoproliferative disorders/lymphoma 2
- Lung cancer 4
- Esophageal squamous cell cancer 3
- Malignant mesothelioma 4
- Cutaneous melanoma 5
Clinical Presentation
The Leser-Trélat sign presents with the sudden appearance of multiple seborrheic keratoses, which can be accompanied by pruritus in half of the patients 2. The lesions rarely require treatment, as they tend to resolve once the underlying malignancy is managed 2.
Pathogenesis
The pathogenesis of the Leser-Trélat sign is not fully understood, but it may be associated with tumor-secreting growth factors, including epidermal growth factor and transforming growth factor-alpha, which can stimulate the epidermal growth factor receptor 2, 4.
Differential Diagnosis
The pseudo-sign of Leser-Trélat is a rare presentation that mimics the true sign but is not associated with an underlying malignancy 6. It is essential to recognize this condition to determine the appropriate course of action.