The sign of Leser-Trélat: does it exist?

The sign of Leser-Trélat is usually regarded as a reliable cutaneous marker of internal malignancy. We have reviewed the literature and conclude that the evidence for a causal relation between eruptive seborrheic keratoses and cancer is meager.     

Sézary syndrome and Leser-Trélat sign: A chance association?

BACKGROUND: Leser-Trélat sign involves the combined sudden onset of seborrheic keratosis and cancer. However, some doubt surrounds the existence of this syndrome. We report a case of Leser-Trélat sign that led to the discovery of Sézary syndrome. PATIENTS AND METHODS: A 59-year-old woman presented generalized pruritus with secondary appearance of multiple seborrheic keratosis. Leser-Trélat sign was diagnosed and 20 months later, Sézary syndrome was discovered. Extracorporeal photopheresis was initiated, after which there was a marked reduction in the patient's pruritus, erythroderma and numbers of seborrheic keratoses and Sézary cells. DISCUSSION: Leser-Trélat sign is often associated with gastric carcinoma or lymphoproliferative tumours. Rampen and Schwengle [J Am Acad Dermatol 21 (1989) 50-5] have thrown doubt on this entity because of the "subjective" definition, the frequent dissociation between the course of the tumour and that of the seborrheic keratosis, the disparity between the frequency with which rapid onset seborrheic keratosis is seen and the rarity of cases in which this phenomenon reveals a tumour and the absence of association with any specific type of malignancy. The time between diagnosis of Sézary syndrome and cutaneous symptoms of Leser-Trélat sign appears very long in the present case. In the absence of any established physiopathology, it is impossible to prove any direct link between these two syndromes. Leser-Trélat sign remains controversial. Knowledge of its pathogenesis could help determine whether Leser-Trélat sign should or should not be considered a paraneoplastic syndrome.     

Sign of Leser-Trélat associated with adenocarcinoma of the rectum

The acute onset and/or rapid increase in size and number of multiple seborrheic keratoses associated with internal malignancy is called sign of Leser-Trélat. Although some authors reject its existence, there are more than 80 well-documented case reports in the literature. Here, we report a 75-year-old man who presented with abrupt appearance of multiple seborrheic keratoses without any suspicious symptom of cancer. The screening for malignant neoplasms let us detect a rectal adenocarcinoma that was in a curative stage. This case-report illustrates a true sign of Leser-Trélat, and proves that these patients must be appropriately investigated for underlying malignancy.     

Clinical and histopathological characteristics of early Leser-Trélat syndrome

Leser-Trélat-syndrome is characterized as the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. A 73 year old female patient with a metastatic adenocarcinoma of the colon presented with this paraneoplastic change. The rapid appearance of solitary seborrheic keratoses with associated inflammation, seen clinically and histologically, may be an early sign of Leser-Trélat-syndrome. The recognition of this inflammatory component as an early sign may contribute to the prompt diagnosis of this paraneoplasia, even before the eruption of numerous seborrheic keratoses.     

Sign of Leser-Trélat with a metastatic mucinous adenocarcinoma.

We describe a middle-aged woman with the sudden onset of multiple seborrheic keratoses in association with a metastatic mucinous adenocarcinoma to the liver from an unknown primary neoplasm. This case illustrates the significance of the sign of Leser-Trélat and its association with cancer.     

Leser-Trélat Sign Associated with Sézary Syndrome

A 74-year-old Japanese male had developed generalized erythroderma and rapid growth of multiple verrucous lesions over the entire surface of his face, trunk, and extremities three months before he was seen. Histologically seborrheic keratoses were revealed. Laboratory examinations showed peripheral leukocytosis with atypical lymphocytes and high levels of IgE and IgG. On the basis of these clinical and histopathologic findings, we diagnosed the patient as having Leser-Trélat sign associated with Sézary syndrome. The erythroderma subsided after administration of oral predonisone, and no new formations of seborrheic keratosis were observed. However, because of subsequent aggravation of the generalized erythroderma, we administered chemotherapy. Six months after the initial examination, lung cancer was found, and the patient subsequently died of respiratory and renal failure.     

Leser-Trélat sign presenting in a patient with recurrent pre-B-cell acute lymphocytic leukemia

The presence of multiple seborrheic keratoses appearing abruptly in association with an underlying malignancy is known as Leser-Trélat sign, a rare paraneoplastic cutaneous syndrome. Although this finding is most commonly associated with solid organ tumors, it also can be a clue for the presence of underlying hematologic malignancies. We present a unique case of Leser-Trélat sign in a 20-year-old man who experienced a relapse of pre-B-cell acute lymphocytic leukemia (ALL) that was previously treated with multiple courses of chemotherapy and external radiation therapy. The patient was admitted for a new cycle of chemotherapy with etoposide and cyclophosphamide and was noted to have an eruption of yellowish brown papules and plaques over his upper body. Biopsy of a representative lesion was consistent with seborrheic keratosis. A large number of rapidly appearing seborrheic keratoses is an uncommon finding in young patients and should be considered clinically suspicious as a potential indicator of Leser-Trélat sign. A thorough history and physical examination should be performed in patients presenting with this sign to rule out possible internal solid organ and hematologic malignancies.     

The sign of Leser-Trélat associated with malignant melanoma

A case of the sudden appearance of multiple pruritic seborrheic keratoses (Leser-Trélat sign) associated with cutaneous malignant melanoma is reported. To the authors' knowledge, this association has not been previously reported.     

Leser-Trélat sign in mycosis fungoides. A further case report

A 61-year-old woman is presented who developed numerous seborrheic keratoses within a few weeks. About 2 months later the patient noticed a progressive generalized erythematosquamous eruption on which the diagnosis of mycosis fungoides was made. PU-VA therapy resulted in complete remission of the mycosis fungoides lesions together with a resolution of the seborrheic keratoses. This is the third report of the Leser-Trélat sign in mycosis fungoides. The cases associated with malignant lymphomas are briefly reviewed.     

The sign of Leser–Trélat associated with transitional cell carcinoma of the urinary-bladder—a case report and short review

Leser-Trélat sign is defined as the sudden appearance of multiple seborrhoeic keratoses in association with internal malignancy. Although 75 cases have been reported to date, controversy still exists about the significance of this sign. The first association of the Leser Trélat sign with transitional cell carcinoma of the urinary-bladder is reported.     

Mycosis Fungoides with Leser-Trélat Sign: The First Report of a Patient from Japan

We describe here a 35-year-old Japanese woman with mycosis fungoides (MF) who developed numerous, rapidly-growing, seborrheic keratoses on the front of her neck and chest. To the best of our knowledge, this is the first reported case of MF with Leser-Trélat sign from Japan.     

THE SIGN OF LESER-TRÉLAT

The sign of Leser-Trélat is the sudden appearance and rapid increase in number of seborrhoeic keratoses on previously normal skin. It is a cutaneous marker of internal malignancy. Two patients exhibiting this sign are described and a further thirty-seven have been found in the medical literature. The main features of these patients are reviewed.     

Acanthosis nigricans maligna and Leser-Trélat sign in double malignancy of the breast and stomach

A female patient with primary cancer of the breast and the stomach developed acanthosis nigricans maligna and Leser-Trélat's sign. Acanthosis nigricans maligna is a well-known cutaneous marker of internal malignancy. It may be intensified by radiotherapy. A variant is called florid cutaneous papillomatosis. Leser-Trélat's sign is a rare cutaneous marker of internal neoplasms. According to the literature, we present 46 patients showing Leser-Trélat's sign. Neither Leser nor Trélat described this sign.     

Leser-Trélat sign associated with Sézary syndrome

The Leser-Trélat sign is a rare but well known cutaneous indicator of internal malignancy, most commonly adenocarcinoma of the stomach. There have been only a few cases associated with lymphoproliferative malignancies. Sézary syndrome is a chronic leukemia/lymphoma characterized by generalized erythroderma and circulating Sézary cells. We describe a rare case of the Leser-Trélat sign associated with the Sézary syndrome. The skin sign was alleviated through combination chemotherapy.     

Seborrhoeic keratoses in patients with internal malignancies: a case–control study with prospective accrual of patients

Background  The association between the eruption of numerous seborrhoeic keratoses as a result of an underlying malignancy is controversially discussed. The aim of this case–control study with prospective accrual of patients was to determine whether a direct association exists between the number seborrhoeic keratoses and internal malignancies.
Methods  The numbers and sites of seborrhoeic keratoses were counted in 150 oncological patients and 150 matched controls. Additionally, the presence or absence of pruritus, acanthosis nigricans, and the sudden appearance of seborrhoeic keratoses were assessed.
Results  Seborrhoeic keratoses did not differ significantly between patients with internal malignancies and controls. Only two patients fulfilled the criteria of the Leser-Trélat sign, defined as the eruption of numerous seborrhoeic keratoses as a cutaneous marker of an underlying internal malignancy.
Conclusion  No association was found between seborrhoeic keratoses and cancer. Furthermore, our data did not provide support to the validity of the Leser-Trélat sign in patients with internal malignancies.     

Paraneoplastic rhinophyma and the Leser–Trélat sign

A case of the Leser-Trélat sign associated with an underlying malignant haemangiopericytoma is described. In addition, the patient had profound hypoglycaemia and a rhinophyma-like nasal swelling which rapidly resolved post-operatively. The tumour appeared to be secreting a factor(s) which cross-reacted with both insulin receptors to induce hypoglycaemia and epidermal growth factor receptors inducing a profusion of eruptive seborrhoeic warts. It aslo had marked sebotrophic activity. The association of the Leser-Trélat sign with malignant haemangiopericytoma has not previously been described.     

Clear cell acanthoma developing in epidermal nevus

A clear cell acanthoma developed in an epidermal nevus of a 73-year-old man who had the Leser-Trélat sign in association with lung cancer. The occurrence of clear cell acanthoma is presumably related to the pathogenesis of the Leser-Trélat sign.     

Florid Cutaneous Papillomatosis, Malignant Acanthosis Nigricans, and Pulmonary Squamous Cell Carcinoma

A 72-year-old man had florid cutaneous papillomatosis (FCP), which is an obligatory paraneoplastic syndrome always associated with an internal malignancy. The cancer, which is usually intraabdominal and most often gastric in origin, evolves parallel to the FCP. This patient is the first case of FCP occurring in association with a lung malignancy. An association of FCP with other signs of internal cancer is common, with malignant acanthosis nigricans usually appearing many times with the sign of Leser-Trélat. FCP, malignant acanthosis nigricans, and the sign of Leser-Trélat are part of a continuum, developing by a common or similar pathogenic pathway due to an underlying malignancy producing a factor possibly similar to human epidermal growth factor.     

Leser-Trélat syndrome, erythema anulare centrifugum Darier, breast cancer and basaliomas in a patient

A 46 year old woman had suffered from Erythema anulare centrifugum Darier (EAC) since 20 years. During a rush of the erythema numerous seborrhoic keratoses appeared (Leser-Trélat sign/LTS). Clinical examination revealed a ductular carcinoma of the breast. During the last two years, both types of lesions increased although the tumor had been treated. In addition, the patient developed several basal cell epitheliomas at forehead and chest.     

Seborrheic keratosis and papillomatosis: markers of breast adenocarcinoma

Seborrheic keratosis (Leser-Trélat sign) and extensive florid papillomatosis of the skin and the mucous membranes of the nose, mouth, throat, and external genitalia were associated with adenocarcinoma of the breast in a 61-year-old woman.