In Leser-Trélat syndrome, a malignant cancer of the internal organs occurs in patients of advanced age, accompanied by numerous age warts. Often, the phenomenon is additionally accompanied by pruritus and acanthosis nigricans. Therapy includes removal of the warts and treatment of the tumor.
What is Leser-Trélat syndrome?
Leser-Trélat syndrome is a rare and paraneoplastic syndrome that occurs primarily in older age. Those affected by the condition grow numerous geriatric warts. The eponym of the phenomenon is its first descriptors Leser and Trélat, who discovered the phenomenon already in the 19th century. Their discoveries were not related to each other. Later it turned out that both of them had actually described senile hemangioma. E. Hollander is also associated with the study of Leser-Trelat syndrome. He speculated in the 20th century about a causal relationship between senile keratoses and malignancies of the internal organs. However, that Leser-Trelat syndrome is actually causally related to malignant cancer remains difficult to prove to this day and is therefore doubted by numerous authors.
Causes
Science is divided on the question of the causes of Leser-Trélat syndrome. Some scientists consider E. Hollander’s speculations to be well-founded and assume another cancer as the cause of senile warts. Usually, according to this opinion, the phenomenon is triggered by a malignant tumor such as adenocarcinoma of the gastrointestinal tract or breast, which are said to release stimulating growth factors. Just as often, malignant lymphomas, leukemia or lung carcinomas are said to be able to trigger the phenomenon. However, since the link with other tumors is difficult to prove, the other half of the scientific community doubts the causal relationship with carcinomas of the internal organs. In about 30 percent of cases, the skin disease acanthosis nigricans is present at the same time as Leser-Trélat syndrome. Therefore, the phenomenon is considered by many authors rather an incomplete form of this dermatological disease.
Symptoms, complaints, and signs
The leading symptom of Leser-Trélat syndrome is sudden onset seborrheic keratoses. The age warts appear particularly numerous and rather diffusely distributed within the syndrome. A particular expression is observed on the trunk of the body. In half of all cases, the age warts are associated with more or less severe itching. The age warts of Leser-Trélat syndrome differ from seborrheic keratoses in the sense of generalized skin rashes in that a malignancy of the internal organs is usually also present. Thus, even though carcinomas of the internal organs may not be the cause of the appearance, in Leser-Trélat syndrome there is an indisputable association between a malignant cancer and the warts. In addition, dirty brown to gray changes in the skin may occur as part of the syndrome. Especially the arms and legs of the patients appear comparatively heavily pigmented in the context of this.
Diagnosis and course of the disease
The first suspicion of Leser-Trélat syndrome is made by eye diagnosis. The history may already be diagnostic if the patient reports carcinomatous disease of the internal organs during the history-taking interview. If a malignant cancer of the internal organs has not yet been diagnosed, the physician may localize existing tumors by imaging if Leser-Trélat syndrome is suspected. At the latest, the detection of these tumors in connection with the age warts is considered diagnostic for the syndrome. In order to assess the malignancy of the carcinomas and to be able to give a prognosis, the physician is usually guided by the WHO. Thus, the prognosis for Leser-Trélat syndrome differs from case to case and is largely determined by the underlying tumor, its location, and treatability.
Complications
Because Leser-Trélat syndrome is a tumor, in the worst case it can lead to the death of the patient. However, this only occurs if treatment for the syndrome is not initiated early and the diagnosis is made late. Patients mainly suffer from itching and severe rashes on the skin.Due to the discomfort, patients also experience reduced aesthetics. Furthermore, Leser-Trélat syndrome leads to the formation of warts on the skin. The warts themselves are very dark. If treatment is not given, the disease can continue to spread and affect other healthy areas of the body. For this reason, immediate treatment is necessary. The affected regions can be removed by surgery. However, it cannot be universally predicted whether the cancer will be completely defeated by removal. Under certain circumstances, Leser-Trélat syndrome will reduce the life expectancy of the affected person. Furthermore, radiation may also be used to treat the symptoms and discomfort of Leser-Trélat syndrome. However, the treatment itself does not lead to further complications.
When should you see a doctor?
Elderly people who suddenly notice skin changes on themselves or suffer from unusual itching should contact their family doctor. At the latest, if severe skin rashes or the characteristic warts appear, this requires medical treatment. Otherwise, the growths may spread to healthy parts of the body and cause further complications in the course of the disease. If severe pain develops, the emergency doctor must be called immediately. The same applies to cardiovascular problems and shortness of breath. Leser-Trélat syndrome occurs predominantly in older people. Seniors who suffer from the aforementioned complaints or who have already had cancer should consult closely with their physician. A comprehensive physical examination is indicated in any case. The right point of contact is the family doctor or a dermatologist. Anyone who feels unwell as a result of the external changes should arrange a consultation with a therapist before serious symptoms develop. Pronounced inferiority complexes or depression require long-term therapy. With children, the pediatrician should be consulted if there are signs of Leser-Trélat syndrome.
Treatment and therapy
If metastases have already formed, curative treatment of Leser-Trélat syndrome carcinoma is no longer possible. As-needed surgery and symptomatic treatments may be able to prolong patients’ lives. However, life expectancy is about eleven months for an aggressive course. In the absence of metastases, therapy for Leser-Trélat syndrome focuses on surgical removal of the tumor. In some circumstances, radiation is also used to kill any cancer cells remaining in the organism. Age warts on the skin are also usually removed. The removal can take place, for example, by means of excision. Alternatively, cryotherapy offers the possibility of freezing the affected area. In this case, the affected tissue is either treated from the outside by means of a cold probe or the cooling agent is injected directly into the warts. In either case, cryotherapy works at temperatures between minus 70 and minus 200 degrees Celsius. A third option is curettage. In this case, the pathologically altered tissue is surgically removed by scraping out the warts with the help of a curette. Usually, the procedures to remove warts take place under local anesthesia and do not require general anesthesia.
Outlook and prognosis
The prognosis of the disease is based on the general health of the affected person as well as the progress of the disease. A particularly severe course may lead to premature death of the affected person. The cancer cells can spread unhindered in the organism, especially without medical care, and lead to the formation of metastases. This process ultimately results in the death of the affected person. Since Leser-Trélat syndrome is characterized by a particularly aggressive form, sufficient treatment measures must be taken in the early stages to ensure a favorable prognosis. However, since the change in skin appearance occurs mostly in people of advanced age, their general state of health is usually already weakened. This has a negative impact on further development. A cancer therapy is absolutely necessary, so that healing prospects are present. The treatment measures place a heavy burden on the human organism. Side effects and loss of quality of life occur.Nevertheless, it is often the only prospect of freedom from symptoms. In addition, the treatment must include surgery by removing the malignant tumors. The procedure is also associated with risks and side effects. If the skin lesions cannot be completely removed, the prospect of recovery worsens. In addition, there is an increased likelihood of recurrence of the disease.
Prevention
Because the causative mechanism of Leser-Trélat syndrome has not yet been conclusively investigated, it is difficult to prevent this disease. If cancer of the internal organs is indeed causative, the genetic level plays a role in the onset of the disease that should not be underestimated. In the case of genetic dispositions, all preventive measures are only effective with limitations anyway.
Aftercare
After the actual treatment of Leser-Trélat syndrome, affected individuals require ongoing care. In addition to regular medical examinations and the use of further therapies, aftercare also includes a change in lifestyle. Those affected should now try to rebuild their quality of life. The support of the responsible physicians as well as relatives and friends is important in order to achieve a good way of dealing with the disease. Exchanging information with similarly ill patients can also help to obtain valuable information that will improve the quality of life. Most patients also suffer from depression or other psychological upsets due to the aesthetic complaints. The changes on the skin can occur in different places and reduce the quality of life of the affected person. Leser-Trélat syndrome can also occur on the internal organs and lead to cancer there as well. Therefore, the further course of this disease depends very much on the time of diagnosis and also on the affected region, so that a general prediction is usually not possible. In many cases, however, the life expectancy of the affected person is reduced. The risk of relapse decreases annually. A rule of thumb is five years, although here too the type of cancer is decisive. Medical rehabilitation may also include the use of anti-hormones and other medications. In cases of protracted disease, follow-up and follow-up care merge. The details of follow-up care are discussed at the discharge consultation or at a separate appointment.
What you can do yourself
Leser-Trélat syndrome poses a threat to the life of the sufferer, so a doctor should be seen immediately. Although patients suffer from the aesthetic stigma caused by the age warts, treatment of the malignant tumor on the internal organs is the first priority. Patients usually experience a considerable psychological burden due to the diagnosis and feel limited in their quality of life. However, emerging depression must under no circumstances cause patients to delay treatment due to a lack of drive. After all, when removing the malignant tumor, it is essential for the success of the treatment that the doctors perform the operation as quickly as possible. This entails a stay in a clinic, with patients adhering to the doctor’s instructions regarding physical activities, rest periods, and the intake of medical agents. After the removal of the tumor, many patients want cosmetic treatment of the age warts, which they find unattractive and disturbing. The removal of the age warts is performed by a dermatologist. Afterwards, sufferers take care not to put additional stress on the irritated skin areas. For this purpose, the dermatologist gives the patient advice on personal hygiene, the use of cosmetic products, and clothing choices, which the affected person follows for a few weeks.
