In the Leser-Trélat syndrome, a malignant cancer of the internal organs occurs in elderly patients, which is accompanied by numerous senile warts. The phenomenon is often accompanied by itching and acanthosis nigricans. Therapy involves removing the warts and treating the tumor.
What is Lesser-Trélat Syndrome?
The cardinal symptom of Leser-Trélat syndrome is suddenly occurring seborrheic keratoses. The senile warts occur in the context of the syndrome particularly numerous and rather diffusely distributed. See AbbreviationFinder for abbreviations related to Lesser-Trélat Syndrome.
Lesser -Trélat syndrome is a rare and paraneoplastic syndrome that occurs mainly in old age. Those affected by the disease grow numerous warts. The phenomenon is named after the first to describe it, Leser and Trélat, who discovered the phenomenon as early as the 19th century. Their discoveries were unrelated. It later turned out that both had actually described the senile hemangioma.
Hollander is also associated with the research into Lesser-Trelat syndrome. In the 20th century he speculated about a causal connection between age-related keratoses and malignancies of the internal organs. However, it is still difficult to prove that the Leser-Trélat syndrome is actually causally linked to a malignant cancerand is therefore doubted by numerous authors.
When it comes to the question of the causes of Lesser-Trélat syndrome, science is divided. Some scientists consider E. Hollander’s speculation to be justified and assume that another type of cancer is the cause of the warts caused by old age. As a rule, according to this opinion, the phenomenon is triggered by a malignant tumor such as an adenocarcinoma of the gastrointestinal tract or breast, which are said to release stimulating growth factors.
Malignant lymphomas, leukemia or lung carcinomas are said to be able to trigger the phenomenon just as frequently. However, since the connection with other tumors is difficult to prove, the other half of science doubts the causal connection 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 to be rather an incomplete form of this dermatological disease.
Symptoms, Ailments & Signs
The cardinal symptom of Leser-Trélat syndrome is suddenly occurring seborrheic keratoses. The senile warts occur in the context of the syndrome particularly numerous and rather diffusely distributed. A special expression can be observed on the trunk. In half of all cases, senile warts are associated with more or less severe itching. The senile warts of Lesser-Trélat syndrome differ from seborrheic keratoses in the sense of generalized skin rashes in that there is usually also a malignancy in the internal organs.
Even if carcinomas of the internal organs may not be the cause of the phenomenon, there is an undisputed connection between a malignant cancer and the warts in the case of Leser-Trélat syndrome. In addition, dirty brown to gray changes in the skin can occur as part of the syndrome. The arms and legs of the patients in particular appear to be comparatively heavily pigmented in this context.
Diagnosis & course of disease
The first suspicion of the Leser-Trélat syndrome arises from visual diagnostics. The anamnesis can already confirm the diagnosis if the patient reports carcinoma of the internal organs during the anamnesis interview. If malignant cancer of the internal organs has not yet been diagnosed, the doctor may use imaging to localize existing tumors if he suspects Leser-Trélat syndrome.
At the latest, the detection of these tumors in connection with the senile warts is considered to confirm the diagnosis of the syndrome. In order to assess the malignancy of the carcinoma and to be able to give a prognosis, the doctor usually uses the WHO as a guide. The prognosis in the case of Leser-Trélat syndrome differs from case to case and is largely determined by the underlying tumor, its localization and the ability to treat it.
Since 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 of the syndrome is not initiated early and the diagnosis is made late. The patients mainly suffer from itching and severe rashes on the skin.
The symptoms also lead to reduced aesthetics in the patients. Furthermore, the Leser-Trélat syndrome leads to the formation of warts on the skin. The warts themselves are very dark. If left untreated, 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 the removal. Under certain circumstances, the life expectancy of the person affected is reduced by the Leser-Trélat syndrome. Radiation can also be used to treat the symptoms and signs of Lesser-Trélat syndrome. However, the treatment itself does not lead to any further complications.
When should you go to the doctor?
Elderly people who suddenly notice skin changes or suffer from unusual itching should contact their family doctor. At the latest when severe skin rashes or the characteristic warts appear, medical treatment is required. Otherwise, the growths can spread to healthy areas of the body and cause further complications as the disease progresses. If the pain is severe, an ambulance must be called immediately. The same applies to cardiovascular problems and shortness of breath.
Lesser-Trélat syndrome occurs primarily in older people. Seniors who suffer from the symptoms mentioned or have already had cancer should consult their doctor closely. A thorough physical examination is always required. The right point of contact is your general practitioner or a dermatologist.
Anyone who feels uncomfortable 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 Lesser-Trélat syndrome.
Treatment & Therapy
If metastases have already formed, a curative treatment of a carcinoma in the context of Leser-Trélat syndrome is no longer possible. Appropriate surgery and symptomatic treatments can eventually prolong the lives of patients. However, the life expectancy for an aggressive course is around eleven months.
If there are no metastases, the treatment of Lesser-Trélat syndrome focuses on surgical removal of the tumor. Radiation may also be used to kill cancer cells that remain in the body. Age warts on the skin are usually removed as well. The removal can take place, for example, by means of excision. Alternatively, cryotherapy can be used to freeze the affected area.
The affected tissue is either treated from the outside using a cold probe or the coolant is injected directly into the warts. In any case, cryotherapy works with temperatures between minus 70 and minus 200 degrees Celsius. A third option is curettage. The diseased tissue is surgically removed by scraping out the warts with a curette. As a rule, the interventions to remove the warts take place under local anesthesia and do not require general anesthesia.
Outlook & Forecast
The prognosis of the disease is based on the general state of health of the person affected and the progression of the disease. If the course is particularly severe, the patient may die prematurely. 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 person concerned.
Since the Leser-Trélat syndrome is characterized by a particularly aggressive form, sufficient treatment measures must be taken in the early stages for a favorable prognosis. However, since the change in the skin’s appearance mostly occurs in older people, their general state of health is usually already weakened. This has a negative impact on further development. Cancer therapy is absolutely necessary in order to have a chance of recovery. The treatment measures place a heavy burden on the human organism. There are side effects and a loss of quality of life. Nevertheless, it is often the only chance of being free of symptoms.
In addition, a surgical intervention must be carried out in the treatment in which the malignant tumors are removed. The procedure is also associated with risks and side effects. If the skin lesions cannot be completely removed, the prospect of recovery is reduced. There is also an increased likelihood of the disease recurring.
Since the causality of the Leser-Trélat syndrome has not yet been conclusively researched, this disease is difficult to prevent. If cancer of the internal organs is actually the cause, 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 to a limited extent.
After the actual treatment of Lesser-Trélat syndrome, those affected need ongoing care. In addition to regular medical examinations and the use of other therapies, a change in lifestyle is also part of the aftercare. Those affected should now try to build up quality of life again.
The support of the responsible doctors as well as relatives and friends is important in order to get a good handling of the disease. The exchange with people who are equally ill can also help to get valuable information that improves 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 those affected.
Reader-Trélat syndrome can also affect 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 region affected, so that a general prediction is usually not possible. In many cases, however, the life expectancy of those affected is reduced.
The risk of recurrence decreases every year. The rule of thumb is five years, although the type of cancer is also decisive here. Medical rehabilitation may also include taking anti-hormones and other medications. In the case of protracted illnesses, follow-up checks and aftercare go hand in hand. The details of aftercare are discussed at the discharge interview or at a separate appointment.
You can do that yourself
Lesser-Trélat syndrome poses a threat to the life of the sufferer, so a doctor must be consulted immediately. Although the patients suffer from the aesthetic blemishes caused by senile warts, the treatment of the malignant tumor on the internal organs is the top priority. Patients usually experience considerable mental stress as a result of the diagnosis and feel restricted in their quality of life. Emerging depressions, however, must under no circumstances lead to patients delaying therapy due to a lack of drive.
Because when removing the malignant tumor, it is essential for the success of the treatment that the doctors carry out the operation as quickly as possible. This involves a stay in a clinic, whereby the patients adhere to the doctor’s instructions regarding physical activity, rest periods and the intake of medicinal substances.
After the tumor has been removed, many patients want cosmetic treatment for their senile warts, which they find unattractive and annoying. A dermatologist removes the age warts. The sufferers then make sure not to put additional stress on the irritated skin areas. The dermatologist gives the patient advice on personal hygiene, the use of cosmetic products and the choice of clothing, which the patient follows for a few weeks.