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Appropriate Radiologic Management of a Controversial Paraneoplastic Dermatologic Sign

Leser-Trélat sign is a paraneoplastic disorder characterized by the eruptive appearance of multiple seborrheic keratoses. Leser-Trélat sign is generally associated with gastrointestinal adenocarcinoma; however, the association with malignancy is controversial. We present the case of a 37 year old male smoker, identified with Leser- Trélat sign and the ensuing clinical decision making and radiologic workup in search of underlying malignancy. Given the patient’s young age and smoking history, chest radiographs and age appropriate primary care managed cancer screening were chosen, in lieu of expensive, higher radiation dose, whole body imaging modalities such as PET or CT. The chest radiographs were normal, and the patient remains cancer free. Further research is needed to elucidate the underlying mechanisms of Leser-Trélat sign, validate its association with malignancy, and generate consensus evidence based medical guidelines with input from all specialties that manage oncologic patients to assist clinicians contain costs, minimize medical radiation exposure, and maintain high level diagnostic accuracy.


Young CR, Wong EE

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