Leukemia Cutis Treatment & Management

Updated: Feb 12, 2019
  • Author: Thomas N Helm, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Leukemia cutis is a local manifestation of an underlying systemic disease; therefore, it should be managed with systemic chemotherapy. Literature on aleukemic leukemia cutis is limited, but because diagnosis of leukemia cutis portends poor prognosis in acute leukemia, the treatment should be directed at eradicating the leukemic clone by using aggressive systemic chemotherapy and stem cell transplant possibly in first remission.

The treatment of leukemia should be determined by the subtype of leukemia and by the patient's ability to tolerate a treatment regimen. This is primarily dependent on the overall medical condition of the patient, including any comorbid conditions that may exist. Under certain circumstances, such as resistant or recurrent skin disease, local treatment in the form of electron beam therapy can be used. However, in most of these cases, reinduction systemic chemotherapy must be added unless medically contraindicated by the patient's comorbidity.

In general, most patients on chemotherapy should receive prophylaxis for common infectious agents, including herpes simplex virus (HSV), Candida species, and P carinii. They should also receive symptomatic treatment for mucocutaneous complications of chemotherapy. These treatments include ketoconazole troches (for thrush) and viscous lidocaine alone or a compound containing lidocaine solution, diphenhydramine hydrochloride, and aluminum hydroxide suspension, ie, "magic mouthwash," (for stomatitis) or chlorhexidine and may relieve symptoms. Symptomatic treatment, including topical steroids, mentholated lotions, or topical lidocaine preparations (Lida-Mantle), for medication- or radiation-induced skin eruptions is often helpful. Preparations containing hyaluronic acid or a medication containing emollients called Biafine can speed the healing of skin with radiation damage.

Patients are usually best managed by a team that includes dermatologists and hematologist and oncologist input.

Refer to Acute Myelogenous Leukemia and Acute Lymphoblastic Leukemia.

Radiation therapy

Radiation therapy can be used to palliate symptoms of pain and pruritus in patients with leukemia cutis who are not candidates for systemic chemotherapy. Addition of radiation therapy to skin lesions after complete response to systemic chemotherapy provides no additional benefit. In a rare instance, radiation may be used to treat isolated skin relapse when bone marrow shows complete remission and no other site of extramedullary relapse is evident. If these patients are subsequently treated with chemotherapy, reports detail severe radiation recall phenomenon occurring with chemotherapy drugs like cytarabine and clofarabine. [41] Treatment options for leukemia cutis are expanding rapidly. Helical irradiation of the total skin (HITS) therapy has been modified as simultaneous integrated boost (SIB)–helical arc radiotherapy of total skin (HEARTS) and used to treat acute myeloid leukemia in someone with disseminated leukemia cutis. [42]

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Surgical Care

Most patients require central venous catheter placement for chemotherapy delivery, if they do not have one.

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Consultations

Consult a hematologist and an oncologist if the patient presents with aleukemic leukemia cutis. Consult with a bone marrow transplantation physician if the patient is a candidate for such intensive therapy. Consider a consultation with a radiation oncologist for skin-directed therapy, if appropriate.

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Diet

Neutropenic patients may be placed on diet of well-cooked foods with avoidance of deli meats, fresh fruits, and fresh vegetables to avoid associated risk of infection.

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Activity

Patients may be cautioned to avoid strenuous activity.

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Complications

Complications include the following:

  • Infection: As previously mentioned, patients are at risk for a variety of opportunistic infections.
  • Bleeding: Bleeding as a result of thrombocytopenia is common.
  • Reactions to chemotherapy
  • Graft versus host disease: Graft versus host disease following bone marrow transplantation is common.
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Prevention

Patients should avoid crowded public places because of the risk of infection. Patients should avoid contact with others who are ill.

Patients should avoid receiving live vaccines. However, this may not apply under certain circumstances. Patients should avoid contact with persons who have been recently vaccinated with live vaccines.

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Long-Term Monitoring

Further biopsies may be performed as required to rule out recurrences, graft versus host disease after bone marrow transplantation (BMT), or unusual infections resulting from immunosuppression. Appropriate prophylactic antifungal, antiviral, and Pneumocystis carinii pneumonia (PCP) agents and supportive growth factor treatment are needed.

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