Do you recognize this ominous sign?

December 12, 2018

Figure 1 Quiz of the Week

A 62-year-old female presents with fatigue and innumerable pruritic, keratotic lesions on her back and neck which she says developed quite suddenly two months ago. A blood test reveals a microcytic anemia with hemoglobin of 9.1 g/dL. 

What is the most likely underlying condition?

View Results
Loading ... Loading ...


Image credit: @kdh113.


Answer: Gastrointestinal malignancy

These lesions are seborrheic keratoses, and their abrupt onset and pruritic nature are indicative of a possible underlying internal malignancy — a finding known as the sign of Leser-Trélat. In this case, colonoscopy supports a diagnosis of colorectal cancer, one of the most common malignancies associated with this sign. The pathogenesis behind this paraneoplastic syndrome is not well understood, but various growth factors produced by the malignancy may be responsible for the sudden eruption of these lesions. In approximately 50 percent of cases, they resolve with treatment of the underlying malignancy.

Read more and join the discussion now at Figure 1!


Explore cases, quiz yourself, and solve medical mysteries along with thousands of other medical professionals around the world on Figure 1, the free app where doctors expand their clinical knowledge.