Tulane University School of Medicine New Orleans, LA
William C. Chastant, MD, Michael Conner, MD, Sehem Ghazala, MD, Jordan J. Karlitz, MD; Tulane University School of Medicine, New Orleans, LA
Introduction: Dermatologic manifestations of gastrointestinal malignancies are a relatively rare presentation. However, these skin findings can be a prompt to survey for and result in early detection of gastrointestinal malignancy resulting in improved patient morbidity and mortality.
Methods: A 77-year-old man with a history of pan-diverticulosis and iron deficiency anemia presented with 24-hours of melena and skin lesions on his back that developed over 3 to 4 days. On Physical examination, his vital signs were normal, had melena on rectal exam, and back showed diffuse, dark-brown, waxy, raised plaques consistent with Leser-Trelat sign (Figure 1). Labs were significant for anemia (hemoglobin 10 g/dL) and elevated blood urea nitrogen (38 mg/dL). An abdominal computed tomography without contrast revealed a 3.4 cm ascending colon mass described as an “apple core” lesion.
The patient underwent esophagogastroduodenoscopy without significant findings. His colonoscopy was significant for blood throughout the colon and a large, 2-2.5 cm rectal mass. Biopsy of the rectal mass revealed tubulovillous adenoma with high-grade dysplasia. A follow up outpatient colonoscopy with endoscopic ultrasound was performed, and the rectal mass removed via endoscopic mucosal resection. Discussion: There are few dermatologic manifestations associated with gastrointestinal malignancies in the adult population. These conditions can be divided into three broad categories: genetic conditions, inflammatory conditions, and para-neoplastic syndromes.1 The genetic conditions include Howel-Evans syndrome, Peutz-Jeghers syndrome, Muir-Torre syndrome, Gardner syndrome, and Cowden syndrome. The inflammatory conditions include dermatomyositis and multicentric reticulohistiocytosis. The paraneoplastic syndromes include sign of Leser-Trelat, acanthosis nigricans, tripe palm, acrokeratosis paraneopalstica, necrolytic migratory erythema, and hypertrichosis lanuginosa.1 Identification of these skin findings in most of the conditions results in an earlier detection of the respective gastrointestinal malignancy, hence, improving patient morbidity and mortality.
References: C. R. Schadt, “The cutaneous manifestations of gastrointestinal malignancy,” Seminars in Oncology, vol. 43, no. 3, pp. 341–346, 2016.
Figure 1 - Sign of Leser-Trelat
Figure 2 - Multicentric Reticulohistiocytosis
Figure 3 - Necrolytic Migratory Erythema
Disclosures: William Chastant indicated no relevant financial relationships. Michael Conner indicated no relevant financial relationships. Sehem Ghazala indicated no relevant financial relationships. Jordan Karlitz indicated no relevant financial relationships.