Diagnostic Considerations
The differential diagnosis for leukemia cutis is broad and can include infectious etiolgies, sarcoidosis, syphilis, as well as reactive infiltrates to arthropod bites.
Leukemia cutis can even mimic granulomatous rosacea. [41] Skin biopsy is critical to making a correct diagnosis.
Differential Diagnoses
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Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma
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Drug-Induced Pseudolymphoma Syndrome
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Lymphocytoma Cutis
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Involvement of the face in a patient with acute myelogenous leukemia. Courtesy of Grant Anhalt, MD.
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Red-brown papules can be seen in leukemia cutis. They are confluent in this patient. Courtesy of Nevena Damjanov, MD, and Elizabeth Prechtel.
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Papules and nodules on the face of an African American patient with acute myelogenous leukemia (AML). Courtesy of Mona Mofid, MD.
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A patient with typical plum-colored lesions seen in leukemia cutis. This patient had acute myelogenous leukemia. Courtesy of Grant Anhalt, MD.
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This photograph shows linear areas, which are more violaceous in color, likely due to trauma to the area, such as excoriation, which results in hemorrhage into the skin. Frequent hemorrhage into the skin can make any inflammatory skin lesion appear more violaceous in patients with leukemia. Courtesy of Nevena Damjanov, MD, and Elizabeth Prechtel.
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Low-power view of leukemia cutis acute myeloblastic leukemia (AML-M1). Note the perivascular and periadnexal infiltrate with relative epidermal sparing. Courtesy of Kim Hiatt, MD.
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This is a higher power view of leukemia cutis acute myeloblastic leukemia (AML-M1). This photo illustrates a perivascular infiltrate of leukemic cells. The nuclei are round to oval with little cytoplasm. Courtesy of Kim Hiatt, MD.
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Leukemia cutis of acute monocytic leukemia. Perivascular and periadnexal infiltration is also present, but the cell morphology is distinct. Many of the nuclei are folded or indented. The cytoplasm of the leukemic cells is gray-blue and more abundant than in the M1 subtype. Courtesy of Kim Hiatt, MD.
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Low-power view of acute promyelocytic leukemia cutis with a perivascular and periadnexal but also interstitial infiltrate, with epidermal sparing but significant upper dermal edema, which could be confused with Sweet syndrome at a low-power view. Courtesy of Kim Hiatt, MD.
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Acute promyelocytic leukemia cutis at high power. The round-to-indented nuclei with prominent cytoplasmic granules are evident. Courtesy of Kim Hiatt, MD.
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Photo illustrates leukocyte esterase staining of the cytoplasm of the leukemic cells in acute promyelocytic leukemia. Courtesy of Kim Hiatt, MD.
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Leukemia cutis at low power demonstrating a Grenz zone and intercalation of leukemic cells between collagen bundles. Courtesy of Keliegh Culpepper, MD.
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Infiltration of leukemic cells between collagen bundles.
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Infiltration of dermoepidermal junction by clonal T cells in Sézary syndrome.
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Diffuse macules and papules on the scalp of a patient with chronic myelogenous leukemia.
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Gingival infiltration in a patient with acute myelogenous leukemia.
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Diffuse truncal eruption of infiltrated papules and plaques in chronic lymphocytic leukemia.
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Close-up photo of diffuse truncal eruption of infiltrated papules and plaques in chronic lymphocytic leukemia.
Tables
Type of Leukemia |
Incidence in the United States |
Percentage of Patients with Leukemia Cutis (%) |
AML |
2.5 cases per 100,000 population |
13 |
Acute lymphocytic leukemia |
1.3 cases per 100,000 population |
3 |
Chronic myelogenous leukemia (CML) |
1-2 cases per 100,000 population |
2-8 |
Chronic lymphocytic leukemia (CLL) |
2.3 cases per 100,000 population |
8 |
Hairy cell leukemia |
0.6-2.9 cases per 1,000,000 population |
8 |
Adult T-cell leukemia |
Extremely low |
40-70 |
Cell Lineage |
CD Antigen Marker |
T cell |
CD45 (LCA) strongly positive CD45RO usually strongly positive CD3 positive but only scattered |
B cell |
CD20 strongly positive but scattered in normal B cells, weakly positive or negative in abnormal small B cells, positive in abnormal large B cells CD43 usually negative |
Granulocytes |
Lysozyme strongly positive in well and poorly differentiated granulocytes Chloroacetate esterase positive in well-differentiated granulocytes CD68 usually negative in all granulocytes CD43 positive, MPO sometimes positive |
Monocytes |
Lysozyme strongly positive in well and poorly differentiated monocytes Chloroacetate esterase usually negative CD68 positive in well-differentiated monocytes CD163 less sensitive but more specific than CD68 CD117 |
