Yogesh Acharya
Avalon University School of Medicine, Willemstad, Curacao, Netherland Antilles
Biography
Dr. Acharya has completed his MD degree in medicine from Tribhuvan University, Kathamndu, Nepal. He is the head of the department of evidence based medicine and epidemiology, biostatistics and preventive health in Avalon University School of Medicine (AUSOM), Willemstad, Curacao, Netherland Antilles. He has published more than 20 papers in reputed journals and is currently the university research chair in AUSOM
Abstract
Leser-trélat sign is a rare but alarming cutaneous sign of the internal malignancy. It possesses a significant difficulty in differentiating between a benign seborrheic keratosis in the elderly patients. We report a case presentation with an incidental skin manifestation resembling seborrheic keratosis, associated with an underlying adenocarcinoma of lung. A 62-year-old-male chronic smoker and heroine abuser who visited the regular drug rehabilitation program was found to have several well-circumscribed, hyper pigmented lesions with stuck on appearance over the chest, abdomen and lower back. These cutaneous lesions were ranging from 8 to12 mm in size consistent with seborrheic keratosis (Fig: 1 and 2). Patient was provided with hydrocortisone cream for it 3 months before that initially decreased the itching. But patient over the course of time noticed more such nodules. He did not have any significant past medical history and maintained normal appetite and weight. The patient was evaluated for possible unknown primary malignancy, and computed tomography (CT) of the chest revealed a mass measuring 3.8x2.9x2.6 cm on the left upper lobe that was encasing the pulmonary artery. He underwent the lung biopsy consistent with moderately differentiated adenocarcinoma. Surgical consultation was done and surgical resection performed followed by chemotherapy. After one year of the diagnosis, the patient has been doing well and is on remission. Although the definitive diagnostic role of Leser-trélat sign is limited, it can be used as a predictor of occult malignancy. It is recommended that the sudden onset widespread seborrheic keratosis should undergo a thorough evaluation.