The Leser-Trélat sign is the explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome

Paraneoplastic syndrome

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. These phenomena are mediated by humoral factors excreted by tumor cells or by an immune response against the tumor...

. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic.

History

It is named for Edmund Leser

Edmund Leser

Edmund Leser was a German surgeon remembered for describing the Leser-Trélat sign. He studied law in Berlin and served in the Franco-Prussian War as an artillery officer before studying medicine in Leipzig. He received his doctorate in 1880, and worked as Richard von Volkmann's assistant in Halle...

 and Ulysse Trélat

Ulysse Trélat

Ulysse Trélat was a French surgeon remembered for describing the Leser-Trélat sign. He was the son of an Army physician, and received his education from his father, Philippe-Frédéric Blandin, Auguste Nélaton and Philibert Joseph Roux. He graduated Doctor of Medicine in 1854, became prosector in...

.

It has been suggested that Leser and Trélat were observing angioma

Angioma

Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls or derived from cells of the tissues surrounding these vessels....

s and not seborrheic keratoses, and so the credit should properly go to Hollander for his 1900 publication.

Associations

Although most associated neoplasms are gastrointestinal adenocarcinoma

Adenocarcinoma

Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Epithelial tissue includes, but is not limited to, the surface layer of skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium can be derived embryologically from...

s (stomach

Stomach

The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

, liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

, colorectal

Colon (anatomy)

The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...

 and pancreas

Pancreas

The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...

), breast

Breast

The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

, lung

Lung

The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

, and urinary tract cancer

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

s, as well as lymphoid malignancies are associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses.

In some cases, paraneoplastic acanthosis nigricans

Acanthosis nigricans

Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the axilla, groin, umbilicus, forehead, and other areas.-Causes:...

 (35% of patients), Florid cutaneous papillomatosis

Florid cutaneous papillomatosis

Florid cutaneous papillomatosis is the sudden onset of numerous cutaneous papillomas that are indistinguishable from viral warts, and associated with underlying malignancy.- History :...

, Ichthyosis acquisita

Ichthyosis acquisita

Ichthyosis acquisita is a disorder clinically and histologically similar to ichthyosis vulgaris.-Associated conditions:...

 (Acquired hypertrichosis lanuginosa), Cowden syndrome

Cowden syndrome

Cowden syndrome is a rare autosomal dominant inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain forms of cancer....

, Tylosis

Tylosis

Tylosis may refer to:In medicine:* Diffuse nonepidermolytic palmoplantar keratoderma* Howel–Evans syndromeIn botany:*Occlusion in the xylem of woody plants as response to injury or as protection from decay in heartwood. See CODIT and Tylosis ....

, Acrokeratosis paraneoplastica of Bazex

Acrokeratosis paraneoplastica of Bazex

Acrokeratosis paraneoplastica of Bazex is a cutaneous condition characterized by psoriasiform changes of hands, feet, ears, and nose, with involvement of the nails and periungual tissues being characteristic and indistinguishable from psoriatic nails...

 and Tripe palms

Tripe palms

Tripe palms are a cutaneous condition characterized by ridged velvety lesions on the palms.It is a paraneoplastic syndrome....

accompanies the sign of Leser-Trélat.

External links

• New Zealand Dermatological Society Includes images