Sign and Pseudo-Sign of Leser-Trélat: Case Reports and a Review of the Literature

May 2013 | Volume 12 | Issue 5 | Original Article | e79 | Copyright © 2013

Zain Husain MD,a Joyce K. Ho,b and Basil M. Hantash MD PhD c

aGeorgetown University Hospital, Washington Hospital Center, Washington DC bStanford University School of Medicine, Stanford, CA cElixir Institute of Regenerative Medicine, San Jose, CA

Abstract

BACKGROUND: Leser-Trélat is distinguished by a rare paraneoplastic sign that is characterized by the sudden eruption of multiple seborrheic keratoses (SKs), associated with underlying internal malignancies. Similar non-malignancy–associated SK eruptions are referred to as the “pseudo-sign of Leser-Trélat” (PLT).
OBJECTIVE: Two cases of rapid SK eruptions, one the sign of Leser-Trélat (SLT) and one PLT, are presented, and the literature on SLT and PLT is reviewed.
METHODS: A literature review of SLT/PLT was performed by searching the PubMed database for all related English published cases.
RESULTS: We identified 109 cases of SLT and 12 cases of PLT, with a mean patient age of 61.8 years. SK eruptions were observed before (68.3%), after (22.1%), and at the time of (9.6%) malignancy diagnosis. The malignancy most frequently associated with SLT was gastric adenocarcinoma. The most common anatomical location of SK eruptions was the trunk (18.9%). Frequently reported associated signs and symptoms included pruritus (52%) and acanthosis nigricans (38.7%). The most common treatment included surgery (35.8%), chemotherapy (26.9%), and radiation therapy (26.9%). Treatment resulted in clinical improvement (45%), no change (30%), exacerbation (15%), or initial improvement followed by exacerbation of SKs. Patient outcomes included disease stability/ improvement (48.4%), recurrence (9.7%), exacerbation/metastasis/new malignancy (4.8%), and death (37.1%).
LIMITATIONS: This was a retrospective study and excluded non-English published cases.
CONCLUSION: This review updates the existing SLT literature and emphasizes the presence of PLT. Clinicians should be aware that SK eruptions may be early manifestations of an internal malignancy or other pathology. To our knowledge, this is the first review examining both SLT and PLT.

J Drugs Dermatol. 2013;12(5):e79-e87.

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INTRODUCTION

The sign of Leser-Trélat (SLT) is the sudden appearance or significant increase in size and number of seborrheic keratoses (SKs) associated with an internal malignancy, especially those of the gastrointestinal tract.1-9 Patients present with multiple SKs appearing on the skin surface, most commonly on the trunk.3.4 This paraneoplastic sign may present with other cutaneous signs, including malignant acanthosis nigricans (AN) and tripe palms. Although SLT is rare, any rapid eruption of SKs should prompt physicians to further investigate the presence of a possible occult internal malignancy, especially if there are other supporting clinical features.

Objective

Two cases of rapid SK eruptions are presented: an 88-year-old man diagnosed with metastatic non-small-cell lung carcinoma (SLT) and an 88-year-old woman with a benign neoplasm of the colon (pseudo-sign of Leser-Trélat [PLT]). The literature on SLT and PLT is also reviewed.

Methods

  1. Case report: Two cases of rapid onset SK eruptions were identified. The patients' clinic progress notes, consultation notes, laboratory studies, imaging studies, and pathology reports were reviewed.
  2. Literature review: A literature review of SLT and PLT was performed by entering the following phrases into the search field of the PubMed database of all the published English literature: “sign of Leser-Trélat,” “pseudo-sign of Leser-Trélat,” “false sign of Leser- Trélat,” “paraneoplastic signs,” and “seborrheic keratoses and malignancy.” Data from other reports cited within publications found in the first-pass were also included.

Results

Case Report 1

An 88-year-old Caucasian male patient with a past medical history of hypertension and hyperlipidemia was referred to our dermatol-

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