Leser–Trélat sign explained

The Leser–Trélat sign is the explosive onset of multiple seborrheic keratoses^[1] (many pigmented skin lesions),^{[2] [3]} often with an inflammatory base. This can be a sign of internal malignancy as part of a paraneoplastic syndrome. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic.

Associations

Although most associated neoplasms are gastrointestinal^[4] 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.^[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] [8] [9]}

Notes and References

1. Schwartz RA . Sign of Leser-Trélat . J. Am. Acad. Dermatol. . 35 . 1 . 88–95 . July 1996 . 8682971 . 10.1016/S0190-9622(96)90502-2 .
2. Book: Odom, Richard B. . Davidsohn, Israel . James, William D. . Henry, John Bernard . Berger, Timothy G. . Clinical diagnosis by laboratory methods . Dirk M. Elston . Andrews' diseases of the skin: clinical dermatology . Saunders Elsevier . 2006 . 638 . 978-0-7216-2921-6 .
3. Web site: Schwartz . Robert A . Sign of Leser-Trelat: Background, Pathophysiology, Etiology . Medscape Reference . 2024-05-16 . 2024-08-08.
4. Gregory B, Ho VC . Cutaneous manifestations of gastrointestinal disorders. Part I . J. Am. Acad. Dermatol. . 26 . 2 Pt 1 . 153–66 . February 1992 . 1552046 . 10.1016/0190-9622(92)70019-C.
5. Heaphy MR, Millns JL, Schroeter AL . The sign of Leser-Trélat in a case of adenocarcinoma of the lung . J. Am. Acad. Dermatol. . 43 . 2 Pt 2 . 386–90 . August 2000 . 10901731 . 10.1016/S0190-9622(00)70301-X.
6. Yaniv R, Servadio Y, Feinstein A, Trau H . 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 . March 1994 . 8050144 . 10.1111/j.1365-2230.1994.tb01143.x. 23468338 .
7. Leser E. Ueber ein die Krebskrankheit beim Menschen haufig begleitendes, noch wenig gekanntes Symptom. Munchener Med Wochenschr. 1901;51:2035-2036.
8. Hollander E. V. Beitrage zur Fruhdiagnose des Darmcarcinomas (Hereditatsverhaltnisse und Hautveranderungen. Deutsche Medicinische Wochenschrift. 1900;26:483-485.
9. Book: Lock. Stephen. Last. John M.. Dunea. George. The Oxford illustrated companion to medicine. registration. 15 July 2011. 2001-12-01. Oxford University Press US. 978-0-19-262950-0. 502–.