Abstract
Leser-Trélat syndrome is characterized by the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas. Herein, we present a case that we believe is the first report of the sign of Leser-Trélat in association with occult gastric adenocarcinoma and the anamnestic oncologic history of five other multiple primitive cancers. Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers. Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses. We propose the importance of combining the molecular features of multiple seborrheic keratoses with EGFR immunohistochemistry analyses to determine the likelihood of Leser-Trélat syndrome and the consequent high risk of underlying multiple visceral malignancies.
Highlights
Skin manifestations are frequently observed in many internal malignancies
Heaphy et al [11] suggest that it would be useful to distinguish between a “sign of LeserTrélat” and a “syndrome of Leser-Trélat.”. They propose that the “sign of Leser-Trélat” be defined as a sudden acute efflorescence of seborrheic keratoses sometimes accompanied by pruritus or acanthosis nigricans
Our report appears to demonstrate that, even when the sign of Leser-Trélat is confirmed by the diagnosis of anamnestic or recent malignancies, patients affected by this syndromic disorder should be carefully monitored for different visceral and potentially multiple primitive malignancies
Summary
Cutaneous lesions, including benign neoplasms or pigmented lesions, can appear in the context of specific genodermatosis [1,2], lentiginosis [3], or paraneoplastic syndrome [4] representing a crucial cutaneous marker of internal malignancy in both the sporadic and genetic setting. Several cutaneous paraneoplastic syndromes may be associated with underlying tumours. The sign of Leser-Trélat is characterized by the eruptive appearance of multiple seborrheic keratoses (SK) in association with underlying malignant disease. Two European surgeons, Edmund Leser and Ulisse Trélat, were the first to describe the sign, and they gave no mention of the presence of seborrheic keratoses reporting a specific association with angiomas - that probably does not exist - their names continue to be linked to a different paraneoplastic association [5]. Endogenous mediators of hyperproliferative skin disease such as epidermal growth factor (EGF), transforming growth factor-alpha (TGF-a), or amphiregulin that may function in a localized autocrine manner or be
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