The sign of leser-trelat

Introduction

Leser-Trelat (LT) sign, first described by Edmund Leser and Ulysse Trelat, characterized by sudden eruption of numerous seborrhoeic keratoses, usually associated with pruritus is taken as a marker of internal malignancy.[1] LT sign associated with gas-tric carcinoma was reported and was thought to be incomplete form of acanthosis-nigricans.[1] LT sign was associated in 20% cases with acanthosis-nigricans.[2] Three cases of LT sign associated with malignancy of large bowel was reported.[3] LT sign in a case of carcinoma lung has also been reported.[5] Ronchese (1965) stated criteria for diagnosis of LT sign as rapid increase of seborrhoeic keratoses, pruritus, previous blemish free skin and associated internal malignancy.[6]

Materials and Methods

Four cases of LT sign were studied in detail to establish their association with malignancy. Detailed history, dermatological examination, and general physical and systemic examination were done. Routine and relevant special investigations were carried out.

Results

Investigations confirmed that 1 out of 4 cases with LT sign had pupillary carcinoma of thyroid [Figure - 1] and the second case had carcinoma body of pan-creas. USG revealed a mass in the gall bladder in the third case but was lost before completion of further investigations. The fourth case did not have any associated abnormality.

Discussion

LT sign may or may not be associated with internal malignancy as was seen in the present study. Sudden appearance of eruptive seborrhoeic keratosis associated with pruritus is essential for diagnosis of LT sign which has to be differentiated from asymptomatic cases where multiple seborrhoeic keratoses develop slowly and progressively although histopathologically both were similar. Our results also confirm that LT sign should be taken seriously and such other cases must be investigated thoroughly.