Leukemia Cutis: a Clinico-Pathologic Study of 23 Patients

Jang, Kyoung Ae; Chi, Doo Hyun; Choi, Jee Ho; Sung, Kyung Jeh; Moon, Kee Chan; Koh, Jai Kyoung

Abstract

BACKGROUND: Leukemia cutis is regarded as a dissemination of aggressive systemic leukemia to the skin. The presence of leukemia cutis is usually associated with a grave prognosis.
OBJECTIVE
We evaluated the differences in the patienta' age and sex, the clinical appearance and distributions of the skin lesions, histopathological characteristics, interval between diagnosis of systemic leukemia and skin involvement, and prognosis according to the type of leukemias.
METHODS
We performed a retrospective study of 23 cases of leukemia cutis. We obtained the clinical characteristics from record reviews and we also reevaluateds biopsy materials of 23 patients diagnosed in Asan Medical Center from 1989 to 1999.
RESULTS
1. The male-female ratio was 1.6 to 1. The mean age at diagnosis was 46.6 years. Leukemia cutis occurred in 4.3% of cases of AML(17/396), 0.4% of ALL(1/276), 9.5% of CML(2/21), and 0% of CLL(0/14) in Asan Medical Center from 1989 to 1999. The patients in this study comprised: 3 patients with myelodysplastic syndrome(MDS), 1 acute lymphocytic leukemia(ALL), 17 acute myelocytic leukemia(AML), and 2 chronic myelocytic leukemia(CML). 2. The clinical appearance of leukemia cutis includes macules, papules, nodules, and erythema nodosum-like lesions. The papular lesions were the most common ones. Trunk and extremities were favored sites. There was no specific difference in the clinical findings of each type of leukemias. 3. Histopathological evaluation revealed perivascular and periadnexal infiltration of leukemic cells in the dermis with grenz zone in more than one third of the specimens. There was no specific difference in the histopathological findings of each type of leukemias. 4. In sixteen of the 23 patients (69.6%) with leukemia cutis, skin lesions developed after the systemic leukemia had been diagnosed. Three of the patients (13%) had skin lesions preceding the diagnosis of systemic leukemia and 4 patients (17%) had concomitant involvement. 5. Eighteen patients (78.3%) died after the diagnosis of leukemia cutis. The mean intervals between diagnosis of leukemia cutis and death was 4.8 months.
CONCLUSION
Leukemia cutis is an uncommon manifestation of leukemia cutis that is strongly associated with the presence of extramedullary disease at other sites. Although AML was the most common type in this study, leukemia cutis has developed in CML, AML, ALL, and CLL in decreasing order of frequency in this study. The lesions showed varied morphology and could be difficult to distinguish both clinically and histopathologically from nonspecific dermatoses. The presence of leukemia cutis may be a sign of grave prognosis.