Leser-Trélat Syndrome in a Male with Breast Carcinoma and Eyelid Basal Cell Carcinoma

Abstract

Purpose: Leser-Trélat syndrome consists of appearance of a solid tumor-like carcinoma breast, colon, or stomach following eruption of multiple seborrheic keratoses (SK) of the skin. We present an unusual and possibly the first case report of Leser-Trélat syndrome in a male patient with a history of mastectomy for breast carcinoma who presented to us with a second malignancy in the form of basal cell carcinoma (BCC) of the lower eyelid. Procedure: A 75-year-old male presented in 2014 with a history of modified radical mastectomy for infiltrating ductal carcinoma of the left breast which was performed 11 years prior to the day of presentation. Breast carcinoma was diagnosed following eruption of multiple SK at the same time. In the previous 3 years he noted a nodulo-ulcerative growth over the lateral aspect of the right lower eyelid which was clinically diagnosed as BCC. Mass excision under frozen section control and lid reconstruction was performed. Diagnosis of BCC was confirmed on histopathological examination of the excised specimen. Results and Conclusions: Though a previously unobserved entity, our case supports the importance of Leser-Trélat sign and its relevance to affected individuals, as early recognition and prompt treatment of a low-stage cancer offers good prognosis.

Leser-trelat sign in the diagnosis of occult neoplasms: Case report

“…It has been observed that in many patients who show the Leser-Trélat sign, another paraneoplastic disease occurs at the same time, so that a careful examination and precise anamnesis cannot be assessed. [2][3][4][5][6][7] As epidermal growth factor (EGF) receptors are present on basal keratinocytes, it has been suggested that greater importance should be given to combining molecular characteristics of multiple SKs with immunohistochemical analyzes of EGFR proteins to determine the likelihood of Leser-Trélat syndrome and consequently a high risk of disease. 8 At the same time, it is suggested for EGFR immunohistochemical analysis to be limited, i.e, to indicate the presence of LTS only when some additional clinical manifestations are present, such as: acute morphological changes in long-standing multiple SK, sudden, multiple "eruption" of SK, association with acanthosis or other paraneoplastic manifestations of the skin, a younger age of the patient at the onset of SK, and malignancies in personal and/or family history.…”

“…Occurrence of numerous seborrheic keratoses (especially if they are "eruptive", large and bizarre in shape [1][2][3][4][5][6][7] ), should raise suspicion of LT phenomenon, or internal malignancy in the patient, and result in relevant diagnostic procedures to detect possible latent malignancy. It would be wise for the doctors of all disciplines to be acquainted with the existence of the LT sign (syndrome) and the possible clinical implications of it.…”

“…1 The LT sign is considered to be a rather rare paraneoplastic skin marker of internal malignancy. [2][3][4][5] Seborrheic keratoses (SK) are very common benign skin changes in the population over 40 years old. SK are also found in completely healthy people.…”

“…In fact, overexpression of EGF-alpha and EGFR (epidermal growth factor receptor) may contribute to the eruptive nature of SK. [1][2][3][4][5][6][7] CASE HISTORY Patient M.O. 73 years old, came for the first time for a dermoscopic examination of the skin in June 2012 due to a change on the head, which was diagnosed as an intradermal nevus without significant elements.…”

Signo de Leser-Trélat

“…El tratamiento consiste en la identificación y el manejo de la neoplasia maligna subyacente, lo cual resuelve las queratosis seborreicas asociadas hasta en un 50% de los pacientes (1,10). La eliminación del resto de lesiones residuales y sintomáticas puede realizarse con diversos métodos físicos, como la crioterapia, el curetaje, la eliminación por afeitado y la electrodesecación.…”