Glaucoma · practice question
What does the sudden eruption of these lesions most warrant?
[READINESS SEED] An older adult suddenly develops a crop of new greasy, "stuck-on," verrucous pigmented lesions on the eyelids and trunk over a few months. What does the sudden eruption of these lesions most warrant?
Show the answer and explanationAnswer and explanation
Answer: A. A search for an occult internal malignancy
Individually, seborrheic keratoses are benign "stuck-on" lesions, but the sudden eruption of many (the sign of Leser-Trélat) is associated with an occult internal malignancy, classically a gastrointestinal adenocarcinoma, and prompts a systemic search. The tempo, not the individual lesion, is the alarm.
Clinical pearl: A single stable seborrheic keratosis needs nothing; it is the sudden multiplicity that carries the systemic implication.