Leser-Trélat Sign

Excerpt

The Leser-Trélat sign is a relatively rare paraneoplastic cutaneous marker of internal malignancy characterized as the finding of multiple seborrheic keratoses that have abruptly erupted. However, no standardized or quantified diagnostic criteria currently define the sign of Leser-Trélat. The sign of Leser-Trélat is frequently found in connection with colon, breast, or stomach adenocarcinomas but has also been associated with renal, hepatic, and pancreatic malignancies. The exact pathophysiology underlying the sign of Leser-Trélat remains elusive, but some experts strongly suspect that the release of cytokines and growth factors from the neoplasm stimulates the eruptive growth of the seborrheic keratoses. However, this sign has been met with a significant amount of skepticism by many, considering the commonality of both seborrheic keratoses and malignancy in elderly patients.

Seborrheic keratoses are nearly ubiquitous benign skin lesions in patients greater than 40 years of age, typically appearing as brown, waxy lesions of varying shapes and sizes on examination. Seborrheic keratoses described in the Leser-Trélat sign are commonly homogenous, well-circumscribed pigmented macules, papules, and plaques with pigmentation ranging from light tones to dark brown or black. The lesions are generally described as having a waxy or velvety texture with a stuck-on appearance but often are in a Christmas tree pattern on the chest, abdomen, or back with or without pruritus. Although these lesions are typically relatively easy to distinguish from other melanocytic neoplasms, a histopathological examination may be required. Clinicians suspecting the Leser-Trélat sign on examination should evaluate the patient for an underlying neoplasm. The primary treatment for Leser-Trélat lesions involves the management of the underlying malignancy, which resolves approximately 50% of associated seborrheic keratoses. In addition, symptomatic lesions may be managed with antipruritic topical creams or more aggressively destroyed with various modalities, including cryotherapy, curettage, shave removal, and electrodesiccation.

The Leser-Trélat sign was first described separately in the 1800s by Edmund Leser and Ulysse Trélat during their study of cherry angiomas in oncology patients. In 1900, Hollander was the first to describe seborrheic keratoses associated with malignancy, but the names Leser and Trélat remained affixed to the condition. By 1988, 60 documented case presentations of the sign were noted.