Eruptive Seborrheic Keratoses Are Associated With a Co-Occurring Malignancy in the Majority of Reported Cases: A Systematic Review

Abstract

Background Eruptive seborrheic keratoses (ESK) is a benign skin condition that has been associated with malignant and nonmalignant diseases. We conducted a systematic review of reported cases of ESK to identify and summarize associated comorbidities. Methods MEDLINE and Embase were searched from database inception (1946) to July 31, 2020 for original articles describing ESK with or without a co-occurring condition. Subject demographics, as well as details of ESK and associated diagnoses were extracted from 76 articles (70 case reports, 3 case series, 3 case control studies) representing 92 patients. Results In total, 76.1% ( n = 70/92) of patients with ESK had a co-occurring malignancy, 4.3% ( n = 4/92) presented with a nonmalignant condition, 9.8% ( n = 9/92) experienced ESK as an adverse drug reaction, and 9.8% ( n = 9/92) did not report any underlying medical condition. ESK preceded a cancer diagnosis in 76.1% ( n = 70/92) of patients with a mean latency period of 4.0 months (range: 0.25-9 months). The most common malignancies associated with ESK were cutaneous T-cell lymphoma ( n = 10/70, 14.3%) and gastrointestinal adenocarcinoma ( n = 9/70, 12.9%). ESK preceded nonmalignant conditions or no disease in 14.1% ( n = 13/92) of patients with a mean latency period of 3.1 months (range: 0.75-6 months). Drug-induced ESK occurred in 9.8% ( n = 9/92) of patients with a mean latency period of 7.1 weeks after changing medication. Conclusion Although the role of ESK as a paraneoplastic cutaneous marker is debated, healthcare providers should consider screening for underlying malignancy in patients presenting with ESK. Larger studies are needed to confirm its role as a marker for disease.

Sudden onset of multiple seborrhoeic keratoses in a patient with well-differentiated neuroendocrine tumours of the gut

“…Medical history and clinical findings were consistent with the diagnosis of a Leser-Trélat sign. Although debated, it is characterised by the sudden appearance of multiple, often pruritic SK or a rapid increase in size and number of pre-existing SK in association with malignancy 1–3…”

“…A large number of tumours, including carcinomas of the colon, rectum, stomach, breast and lung, have been described in association with this paraneoplastic sign 1–3. A pathogenetic role for cytokines and growth factors produced by the neoplasm is assumed 1–3…”

“…Tumour screening is recommended in case of abrupt new development of multiple pruritic SK or increase in number and size of pre-existing SK, especially in elderly persons 2 3. Nevertheless, sudden appearance of SK in elderly persons without a detectable malignancy is possible (‘pseudo-sign of Leser-Trélat’) 2…”

“…After appropriate treatment of the underlying cancer, some patients experience improvement of their SK lesions 3. Recurrence of SK following tumour treatment can indicate a relapse of the primary cancer or a new malignancy 3…”

“…In regard to SK, several treatment options exist, including curettage, cryotherapy and laser ablation 2 3…”