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Images of Memorable Cases: Case 129

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_129-pres1-1.jpg

A cutaneous marker of internal malignancy described in the 19th century by two surgeons, Edmund Leser (German) and Ulysse Trélat (French). This sign refers to the sudden appearance and rapid increase in size and number of seborrheic keratoses on skin that was previously blemish-free. In most of the reported cases, adenocarcinoma has been the commonest tissue type, while the gastrointestinal tract has been the commonest site of origin. Other tissue types have included leukemias, lymphomas, sarcomas, and squamous cell carcinomas.

The seborrheic keratoses may precede, accompany, or follow detection of the primary tumor and may regress or disappear when the primary tumor is treated. Why these keratoses appear remains speculative.

In the patient shown, squamous cell carcinoma of the lung was the primary tumor. Note the thoracotomy scar beneath the left scapula.

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