Leukemia Cutis: An Illustrative Case and Literature Update

Summary: Leukemia cutis is associated with a wide variety of presentations. Skin tropism is thought to be influenced by chemokine receptors and adhesion molecules. We present the illustrative case of a 67-year-old man who presented to our emergency department with 3 weeks of generalized weakness and lightheadedness. Bone marrow revealed acute myeloid leukemia. Biopsy of his chest rash revealed a diffuse interstitial infiltrate indicative of leukemia cutis. Although leukemia cutis most often presents as erythematous papules and nodules, it can mimic many other dermatoses including drug eruptions, folliculitis, vesicles, desquamation, and petechiae. Unique presentations occur across skin tones including pruritis and eyelid edema in skin of color. Eruptions preferentially occur at sites of prior inflammation, which likely explains why our patient first noticed lesions overlying his pacemaker. In about 7% of patients, skin lesions are the first sign of underlying hematologic malignancy. We review the clinical presentations and diagnostic features of leukemia cutis to assist clinicians in making a prompt diagnosis.