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The Clinical Picture

The Leser-Trélat sign

Christopher Sardon, MD, MPH and Timothy Dempsey, MD, MPH
Cleveland Clinic Journal of Medicine December 2017, 84 (12) 918; DOI: https://doi.org/10.3949/ccjm.84a.17021
Christopher Sardon
Flight Surgeon, Uniformed Services University of the Health Sciences, Tinker Air Force Base, OK
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Timothy Dempsey
Department of Internal Medicine, University of California Davis, Sacramento, CA
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An 85-year-old woman presented with night sweats, dry cough, and an unintended 30-pound weight loss over the preceding 6 months. She also reported the sudden onset of “itchy moles” on her back.

Physical examination revealed multiple brown papules with a “stuck-on” appearance on her upper back, consistent with seborrheic keratoses (Figure 1), raising concern for the Leser-Trélat sign.

Figure 1
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Figure 1

Multiple seborrheic keratoses on the patient’s upper back.

Computed tomography of the chest, abdomen, and pelvis revealed a left lower lobe lung mass extending through a diaphragmatic hernia and into the stomach and spleen and a metastatic lesion in the liver (Figure 2). A biopsy of the lung mass demonstrated squamous cell carcinoma of pulmonary origin.

Figure 2
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Figure 2

Computed tomography shows a left lung mass extending through the diaphragm and into the stomach with one metastatic lesion in the liver.

KERATOSES AND MALIGNANCY

The Leser-Trélat sign is the sudden development of multiple pruritic seborrheic keratoses, often associated with malignancy.1–4 Roughly half of these associated malignancies are adenocarcinomas, most commonly of the stomach, breast, colon, or rectum. However, it can be seen in other malignancies, including lymphoma, leukemia, and squamous cell carcinoma, as in this case.

Eruption of seborrheic keratoses has also been observed with benign neoplasms, pregnancy, human immunodeficiency virus infections, and the use of adalimumab, which indicates that the Leser-Trélat sign is not very specific. Despite these concerns, the eruption of multiple seborrheic keratoses should continue to trigger the thought of an internal malignancy in the differential diagnosis.

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REFERENCES

  1. ↵
    1. Ehst BD,
    2. Minzer-Conzetti K,
    3. Swerdlin A,
    4. Devere TS
    . Cutaneous manifestations of internal malignancy. Curr Probl Surg 2010; 47:384–445.
    OpenUrlPubMed
    1. Schwartz RA
    . Sign of Leser-Trélat. J Am Acad Dermatol 1996; 35:88–95.
    OpenUrlCrossRefPubMed
    1. Ellis DL,
    2. Yates RA
    . Sign of Leser-Trélat. Clin Dermatol 1993; 11:141–148.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Thiers BH,
    2. Sahn RE,
    3. Callen JP
    . Cutaneous manifestations of internal malignancy. CA Cancer J Clin 2009; 59:73–98.
    OpenUrlCrossRefPubMed
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Cleveland Clinic Journal of Medicine: 84 (12)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 12
1 Dec 2017
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The Leser-Trélat sign
Christopher Sardon, Timothy Dempsey
Cleveland Clinic Journal of Medicine Dec 2017, 84 (12) 918; DOI: 10.3949/ccjm.84a.17021

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The Leser-Trélat sign
Christopher Sardon, Timothy Dempsey
Cleveland Clinic Journal of Medicine Dec 2017, 84 (12) 918; DOI: 10.3949/ccjm.84a.17021
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