6)Leser-Trélat徴候

The Sign of Leser-Trélat

　Leser-Trélat徴候は内臓悪性腫瘍の皮膚徴候(dermadrome)の1つであり，脂漏性角化症(老人性疣贅)が短期間(多くの場合6か月以内)に出現して急速に増加，増大を来した場合，内臓悪性腫瘍が存在する可能性があるというものである．われわれの経験した症例は71歳の女性で，直腸癌発見の9か月前より体幹を中心に脂漏性角化症が多数出現し，急速にその数と大きさが増したためLeser-Trélat徴候と考えらた．本邦報告例114例を加え検討をしたところ，合併疾患は胃癌58例(50.4％)と最多で，次いで大腸癌12例(10.4％)，と，消化管悪性腫瘍が多い傾向にあった．脂漏性角化症は日常診療においてしばしば認められる皮疹であるが，Leser-Trélat徴候においては皮疹が急速に増悪を来すことが重要であり，皮疹の変化を注意深く観察し，本徴候を見過ごさないことが悪性腫瘍の早期発見につながると考えられた．

　The sign of Leser-Trélat is a skin symptom which is definitely related to visceral malignancy (Dermadrome). When seborrheic keratoses suddenly appears and rapidly increases in number and size (during a period of 6 months), it is a sure sign a visceral malignancy. In our case, a 71-year-old female, seborrheic keratoses suddenly appeared and rapidly increased on her skin, nine months before a rectal cancer was detected. We recognized the skin lesions as the sign of Leser-Trélat.

　We also investigated the types of malignancy with the Leser-Trélat sign among 115 reported cases in Japan (including our case). There were 58 cases of gastric cancer (50.4％) and twelve cases of colorectal cancer (10.4％). Most of the cases were malignancy of the gastrointestine. Patients with seborrheic keratoses are often encountered, but the sudden appearance and rapid increase of the eruption is the important sign that indicates intestinal malignancy. Careful observation of the sudden opread of seborrheic keratoses is one of the ways to detect malignancy in its earlier stage.