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Dermatology · Skin tumours: seborrhoeic keratosis
Sample itemAn elderly man suddenly develops numerous itchy seborrhoeic keratoses over the trunk. Which diagnosis should be excluded?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. An internal malignancy, such as gastric adenocarcinoma
The sign of Leser-Trelat is the abrupt eruption of multiple seborrhoeic keratoses and may indicate an underlying visceral malignancy, most often adenocarcinoma of the stomach or colon. Seborrhoeic keratoses are otherwise benign, stuck-on, waxy lesions.
Option by option
A. Scabies
Scabies produces burrows and itch without keratoses.
B. Hypothyroidism
Hypothyroidism causes dry skin but not this eruption.
C. Contact allergy
Contact allergy causes eczema.
D. An internal malignancy, such as gastric adenocarcinoma (correct)
Correct. Sudden eruptive keratoses call for a search for malignancy.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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