Leukemias of the skin C95.9

Specific skin infiltrates in various forms of leukaemia.

Specific skin infiltrates are found in the following forms:

• Lymphatic leukemias:
  • Chronic lymphatic leukemia of the B-cell type
  • Hair cell leukemia (rare)
  • Lymphoblastic lymphoma/leukemia(rare)
  • "T-cell large lymphocytic leukemia" (rare)
  • Prolymphocytic leukemia (rare).
• Myeloid leukemias with skin involvement:
  • Myelosis cutis circumscripta basophilica
  • Myelosis cutis circumscripta eosinophilica
  • Monocytic leukemia
• Cutaneous extramedullary hematopoiesis (see also Blueberry muffin baby).

Clonal growths of the leukopoietic, myeloid or lymphatic system.

Occurrence of dermatological symptoms usually only after clinical diagnosis. Skin symptoms are rarely observed as a primary manifestation of the disease.

• Lymphatic leukemia (more than 90% B-cell type, approx. 10% T-cell type):
• Specific skin symptoms (in 10% of patients): Generalized swelling of lymph nodes and leukemic exanthema: Red to red-blue, possibly maculopapular efflorescences, flat to bulbous, coarse infiltrates, especially in the area of forehead, cheeks, nose and ears. Cutaneous tumours also occur, in some cases the tumours and infiltrates conflate to form facies leontina. Furthermore: Lymphadenosis cutis circumscripta.
• Non-specific skin symptoms (leukaemids, in 28% of patients): pruritus, prurigo, chronic urticaria, petechiae, purpura, ecchymosis, zoster generalisatus, herpes simplex.
• Myeloid leukaemia:
• Specific skin symptoms (relatively rare): plate-like to nodular infiltration of the skin.
• Non-specific skin lesions: paleness in secondary anaemia, bleeding in the skin and mucous membranes with a tendency to ulcerous-necrotic transformation, especially in acute myeloid leukaemia; generalised pruritus, prurigo simplex subacuta, macular, nodular, figured erythema; erythrosquamous or vesiculobullous eruptions; very rarely universal non-specific erythroderma.
• Immature, acute leukoses (myelo- or paramyeloblastic leukemia)
  :Thrombopenic purpura, development of necroses with a tendency to disintegrate in the oral cavity, genital and anal area (by accompanying granulocytosis), candidiasisof
  the mucous membranes, gingival hyperplasia, possibly generalized lymph node enlargement.

Blood count, sample excision with histology and immunohistology, chromosome analysis (in chronic lymphatic leukemia in approx. 90% Philadelphia chromosome).

Treatment of the underlying disease by haematooncologists. Treatment of skin changes depending on the clinic.

1. Chen VM et al (2003) Extramedullary presentation of acute leukaemia: a case of myeloid/natural killer cell precursor leukaemia. Pathology 35: 325-329
2. Damian D et al (2003) Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin. Int J Dermatol 42: 724-726
3. Hill A, Metry D (2003) Urticarial lesions in a child with acute lymphoblastic leukemia and eosinophilia. Pediatric Dermatol 20: 502-505
4. Kazakov DV et al (2003) Blastic natural killer-cell lymphoma of the skin associated with myelodysplastic syndrome or myelogenous leukaemia: a coincidence or more? Br J Dermatol 149: 869-876
5. Katz KA (2003) Disseminated cutaneous granulomatous eruption occurring in the setting of myelodysplasia. Dermatol Online J 9: 22
6. Levy I et al (2003) Ecthyma gangrenosum caused by disseminated exserohilum in a child with leukemia: a case report and review of the literature. Pediatric Dermatol 20: 495-497
7. McCollum A et al (2003) Unusual skin lesions in chronic myelomonocytic leukemia. South Med J 96: 681-684
8. Yagi H et al (2003) Cutaneous type of adult T cell leukemia/lymphoma: a new entity among cutaneous lymphomas. J Dermatol 30: 641-643