Leser-Trelat Sign
It is considered to be a fairly rare paraneoplastic cutaneous marker of internal malignancy with the hallmark finding being an abrupt eruption of multiple seborrheic keratoses. ⠀ ✅It may precede, occur concurrently, or start after the diagnosis of malignancy. ⏩The most commonly implicated malignancies include gastrointestinal adenocarcinomas (gastric, colon, rectal), with gastric adenocarcinoma being the overall most common malignancy, followed by breast cancer, and lymphoproliferative disorders/lymphoma. ⏩CURTH'S POSTULATES are a well-known set of clinical criteria that were created to help evaluate the temporal relationship between an underlying malignancy and a specific dermatological condition. ⠀ ⏩The criteria are as follows: ✅Both the neoplastic and paraneoplastic process began concurrently ✅Both the neoplastic and paraneoplastic processes have a parallel disease course (i.e., paraneoplastic process resolves with treatment of the underlying malignancy, and paraneoplastic process relapses if malignancy returns)⠀ ⠀ ✅The paraneoplastic process is associated with specific types of malignancy⠀ ⠀ ✅The skin lesions are not associated with any potential underlying genetic syndromes⠀ ⠀ ✅The skin lesions are not common in the general population⠀ ⠀ ✅There is a strong statistical association of the paraneoplastic process with truly having an underlying malignancy.⠀ ⏩Release of cytokines and growth factors from the neoplasm are stimulating the eruptive growth of the seborrheic keratoses. Particularly, the overexpression of EGF-alpha and EGFR may contribute to the eruptive nature of these lesions.⠀ ⠀ ⏩Seborrheic keratoses are a nearly ubiquitous, benign skin lesion in patients greater than 40 years of age.⠀ ⠀ ⏩The typical morphology of these lesions tends to vary extensively amongst patients and may present as a macule, papules, and plaques.⠀ ⠀ ⏩Interestingly, many patients truly displaying the sign of Leser-Trelat will concurrently experience another paraneoplastic disease process. ⏩The mainstay of TREATMENT involves management of the underlying malignancy which results in resolution of associated seborrheic keratoses in about 50% of patients. ✅In addition, symptomatic lesions may be destroyed with various physical methods including cryotherapy, curettage, shave removal, and electrodesiccation. ✅Patients with asymptomatic lesions require no further treatment for the seborrheic keratoses besides the treatment of their malignancy. ⏩Eruptive seborrheic keratoses have been reported in numerous other clinical scenarios including in patients with erythroderma, pregnant patients, HIV-infected patients, and transplant patients. ✅Seborrheic keratoses may be confused with a plethora of other cutaneous growths including verruca vulgaris, acrochordons, nevi, solar lentigos, lichenoid keratoses, and even cutaneous malignancies such as squamous cell carcinoma or melanoma. By: https://www.instagram.com/p/CZ_yKszBQwm/?utm_medium=copy_link
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