The Leser-Trelat sign is the rapid appearance of multiple seborrheic keratoses and is indicative of internal malignancy.
Seborrheic keratosis is a benign neoplasm that commonly appears on the extremities, face, and trunk of the elderly. Lesions are round, pigmented and greasy. They appear ‘coin-like’ or ‘stuck-on.’ The Leser-Trelat sign is most commonly associated with adenocarcinomas of the gastrointestinal tract, especially gastric adenocarcinoma, but may also be associated with lung, breast, urinary tract, and lymphoid cancers.
Beachem reviews skin tumors in the elderly. Seborrheic keratoses, lentigo, keratoacanthoma, epidermal cyst and sebaceous hyperplasia are some of the common benign lesions found in older patients. Actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma and melanoma are lesions that are premalignant or malignant.
Ramos-E-Silva et al. review cutaneous signs of neoplasia. They report that the Leser-Trélat sign is secondary to the presence, known or unknown, of a neoplasia. The rapid growth of skin lesions most commonly affects the trunk, followed by the extremities, face, abdomen, and neck.
Figure A shows many seborrheic keratoses on the back of a person with Leser–Trélat sign due to colon cancer.
Answer 1: In immunocompromised patients, the Epstein-Barr Virus (EBV) is associated with hairy leukoplakia, marked by white, painless plaques on the tongue.
Answer 3: Hepatitis C is associated with lichen planus, a chronic rash of pruritic, purple, polygonal papules most commonly found near the wrist and ankles.
Answer 4: Hyperlipidemia is associated with xanthomas, which are yellow, cholesterol rich deposits within the skin or other body parts.
Answer 5: Insulin resistance is associated with acanthosis nigricans, a velvety, pigmented hyperplasia of the stratum spinosum that most commonly appears in body folds such as the axilla.
Beacham BE. Common skin tumors in the elderly. Am Fam Physician. 1992 Jul;46(1):163-8. Review.
PMID:1621628 (Link to Abstract)
Ramos-E-Silva M, Carvalho JC, Carneiro SC. Cutaneous paraneoplasia. Clin Dermatol. 2011 Sep-Oct;29(5):541-7
PMID:21855730 (Link to Abstract)
USMLE World Step 1 Qbank Question #1112. Copyright © USMLEWorld, LLC 2012