Variability of Leser-Trélat Sign Secondary to Melanoma In Situ

TL;DR

This paper presents a rare case where a subtle skin pattern, known as Leser-Trélat sign, was linked to melanoma, highlighting the importance of recognizing subtle skin changes.

Contribution

The paper reports the first case of Leser-Trélat sign with a subtle pattern associated with melanoma in situ.

Findings

A 64-year-old patient presented with a subtle skin pattern linked to melanoma in situ.

The case contrasts with previously documented eruptive LTS-melanoma cases.

The re-excision confirmed absence of residual melanoma after initial biopsy.

Abstract

Leser-Trélat sign (LTS) is characterized as an eruptive display of multiple seborrheic keratoses (SKs) in association with malignancy. This case highlights the variable presentation of LTS secondary to melanoma. To our knowledge, this LTS pattern is the first case where the sign manifests as a subtle pattern secondary to melanoma. This stands in contrast to the five documented cases in the literature of LTS-melanoma, which exhibited distinctive and eruptive patterns.

A 64-year-old Caucasian female presented for a wellness examination. No personal history of skin cancer was noted. Patient displayed an onset proliferation of SKs with an irregular, sub-centimeter macular nevus over her right lateral mid back. A 6mm punch biopsy was significant for melanoma in situ, arising within a lentiginous compound dysplastic nevus, focally abutting one peripheral tissue edge. A re-excision with a minimum of 5mm margins was completed and the specimen was negative for residual in situ melanoma.

Because of the rare occurrence of this delicate pattern at the site of the melanoma, this presentation adds to the knowledge surrounding this diagnosis. This case emphasizes the importance of maintaining vigilance regarding skin manifestations associated with disease and highlights the critical importance of observation and identification of subtle physical exam findings.

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