By Gary M. White, MD
Classically, leukemic involvement of the skin has been separated into leukemia cutis (invasion of the skin by malignant leukemic cells) and leukemids (skin changes associated with leukemia but without the presence of leukemia cells in the skin). Very rarely, leukemic vasculitis may occur in which malignant cells invade blood vessels causing damage.
Leukemia cutis may appear as macules, papules, nodules, ulcerative lesions, ecchymoses, and tumors. Red, pink, or plum-colored are possible colors. This may represent the first manifestation of leukemia in a previously healthy patient, acute transformation in a patient with myelodysplastic syndrome, or another manifestation of leukemia in a patient already known to have that disease. Epstein-Barr virus may be associated.
Leukemids may take the form of generalized itching, exfoliative erythroderma, pyoderma gangrenosum, hemorrhagic lesions, erythema multiforme, erythema nodosum, urticaria, panniculitis, hyperpigmentation, and morbilliform eruptions.
Leukemic vasculitis may present as tender purpuric papules and plaques, and lesions with hemorrhagic cursing and necrosis [JAMA Derm 2016;152;571].
The bullous subtype of LC is rare and clinically mimics bug bites.
Leukemia cutis caused by acute myelogenous leukemia.
Courtesy Micheal O. Murphy, MD
Zosteriform B-Cell Chronic Lymphocytic Leukemia Infiltration. A 77-year-old woman, known to have chronic lymphocytic leukemia, developed multiple red, erythematous, pruritic papules in a zosteriform distribution on her trunk over a 4-week duration. Dermatology Online Journal 17(9)
Indian J Dermatol Venereol Leprol 2010;76:710-2
Aleukemic Leukemia Cutis. Acta Dermato-Venereologica 2011;91;203
Unilateral Purpura from B-Cell Leukemia. JAAD Case Reports March 2015 Volume 1, Issue 2, Pages 49–50
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