Leser-Trélat sign

Leser-Trélat sign is a rare cutaneous condition characterized by the sudden appearance of multiple seborrheic keratoses, which are benign skin growths. This phenomenon is often associated with an underlying malignancy, making it a significant marker in the field of oncology. The sign is named after Edmund Leser and Ulysse Trélat, who first described the association in the late 19th century.

Etiology and Pathophysiology

The exact mechanism behind Leser-Trélat sign remains unclear. However, it is hypothesized that certain growth factors or cytokines secreted by tumors may stimulate the rapid growth of seborrheic keratoses. Epidermal growth factor (EGF) and transforming growth factor alpha (TGF-α) are among the factors suspected to play a role in this process.

Clinical Presentation

Patients with Leser-Trélat sign typically present with a sudden eruption of seborrheic keratoses. These lesions are usually brown, but can vary in color, and have a warty, greasy appearance. They are most commonly found on the trunk, face, and extremities. While the lesions themselves are benign and not harmful, their sudden appearance can be a sign of an internal malignancy, most commonly adenocarcinoma of the gastrointestinal tract, breast cancer, or lung cancer.

Diagnosis

The diagnosis of Leser-Trélat sign is primarily clinical, based on the sudden appearance of multiple seborrheic keratoses and the presence of an underlying malignancy. There are no specific laboratory tests or imaging studies for the sign itself, but investigations are directed towards identifying the associated malignancy.

Treatment

Treatment of Leser-Trélat sign involves addressing the underlying malignancy. The seborrheic keratoses do not require treatment unless they are symptomatic or for cosmetic reasons. In such cases, options include cryotherapy, curettage, or laser therapy.

Prognosis

The prognosis of Leser-Trélat sign is directly related to the underlying malignancy. The sign itself does not affect prognosis, but it may serve as an early indicator of cancer, potentially allowing for earlier diagnosis and treatment.

Conclusion

Leser-Trélat sign is a rare but important marker of internal malignancy. Its presence warrants a thorough investigation for associated cancers. Awareness of this sign among healthcare professionals can aid in the early detection of malignancies, potentially improving patient outcomes.