Leser–Trélat sign

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Leser–Trélat sign
Seborrheic keratosis on human back.jpg
Many seborrheic keratoses on the back of a person with Leser–Trélat sign due to colon cancer
SpecialtyDermatology
SymptomsSudden onset many seborrheic keratoses: dark waxy and velvety spots and bumps in a symmetrical pattern[1]
Usual onsetAdult (60s)[2]
CausesCancer[1]
TreatmentTreat underlying cancer[2]
Prognosis50% persist following cancer treatment
FrequencyRare[2]

The Leser–Trélat sign is the sudden occurrence of many seborrheic keratoses, associated with an internal cancer as part of a paraneoplastic syndrome.[1] These spots and bumps occur in a symmetrical pattern most frequently on the back.[2] They characteristically appear waxy and velvety with a stuck on look.[2] There may be other skin signs of internal cancer such as acanthosis nigricans or tripe palms.[1] Onset is typically in the seventh decade of life.[2]

The association with cancer is unclear; both occur in older age groups.[2] 60% of associated cancers are adenocarcinomas typically of the gastrointestinal tract.[1] Other cancers include lung, breast, and lymphoma.[1] An abrupt eruption of seborrheic keratoses has been reported in other non-cancerous conditions; erythroderma, pregnancy, HIV, and following a transplantation.[2] Treatment is of the underlying cancer.[2] Following cancer treatment, 50% of the seborrheic keratoses tend to persist.[2]

The sign is rare.[2] It is named for German surgeon Edmund Leser and French surgeon Ulysse Trélat, although a more accurate description was given by Eugen Von Hollander in 1900.[3][4]

Associations

Although most associated neoplasms are gastrointestinal.[1] adenocarcinomas (stomach, liver, colorectal and pancreas), malignancies of the breast, lung,[5] and urinary tract,[6] as well as lymphoid tissue, have been associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses.

In some cases, paraneoplastic acanthosis nigricans (35% of patients), florid cutaneous papillomatosis, ichthyosis acquisita (acquired hypertrichosis lanuginosa), Cowden syndrome, tylosis, acrokeratosis paraneoplastica of Bazex or tripe palms accompany the sign of Leser–Trélat.

History

It is named for German surgeon Edmund Leser and French surgeon Ulysse Trélat.[2][7] It has been suggested that Leser and Trélat were observing angiomas and not seborrheic keratoses, and so the credit should properly go to Hollander for his 1900 publication.[3][4]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "29. Epidermal nevi, neoplasms, and cysts". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 641. ISBN 978-0-323-54753-6. Archived from the original on 2023-08-02. Retrieved 2023-07-31.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Bernett, Courtney N.; Schmieder, George J. (2022). "Leser-Trelat Sign". StatPearls. StatPearls Publishing. PMID 29261959. Archived from the original on 2023-03-11. Retrieved 2023-07-31.
  3. 3.0 3.1 Salimi, Maryam; Al-Kutubi, Huda; Andrew, Kashini; Patel, Pooja; Orpin, Stephen; Heagerty, Adrian (26 June 2023). "H04 The sign of Leser–Trélat: an eponymous misnomer?". British Journal of Dermatology. 188 (Supplement_4). doi:10.1093/bjd/ljad113.286. Archived from the original on 2 August 2023. Retrieved 31 July 2023.
  4. 4.0 4.1 Hollander E. V. Beitrage zur Fruhdiagnose des Darmcarcinomas (Hereditatsverhaltnisse und Hautveranderungen. Deutsche Medicinische Wochenschrift. 1900;26:483-485.
  5. Heaphy MR, Millns JL, Schroeter AL (August 2000). "The sign of Leser-Trélat in a case of adenocarcinoma of the lung". J. Am. Acad. Dermatol. 43 (2 Pt 2): 386–90. doi:10.1016/S0190-9622(00)70301-X. PMID 10901731.
  6. Yaniv R, Servadio Y, Feinstein A, Trau H (March 1994). "The sign of Leser-Trélat associated with transitional cell carcinoma of the urinary-bladder--a case report and short review". Clin. Exp. Dermatol. 19 (2): 142–5. doi:10.1111/j.1365-2230.1994.tb01143.x. PMID 8050144. S2CID 23468338.
  7. Leser E. Ueber ein die Krebskrankheit beim Menschen haufig begleitendes, noch wenig gekanntes Symptom. Munchener Med Wochenschr. 1901;51:2035-2036.