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A healthy 65-year-old man presented with a 4-month history of left flank pain and nocturia. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous 1 to 2 years (Panels A and B). Abdominal ultrasound examination and computed tomography (CT) revealed a localized mass (7 cm by 5 cm in diameter) of the left lower renal pole with central necrosis. A left total nephrectomy was performed, and histopathological examination confirmed a renal-cell carcinoma. The tumor infiltrated to, but did not penetrate, Gerota's fascia. The cutaneous findings were consistent with the diagnosis of the Leser–Trélat sign, which is usually associated with gastrointestinal adenocarcinoma. This sign is a controversial physical finding, however, since seborrheic keratoses are common with aging. Four months after the initial diagnosis, thoracic CT showed multiple metastatic lesions in the lung, for which the patient received immunotherapy and chemotherapy. He continues to receive treatment with sunitinib.
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