Leukemia cutis and other dermatological findings in pediatric patients with acute myeloid leukemia

Abstract

Background: Leukemia cutis (LC) is the infiltration of neoplastic leukocytes into the skin, causing skin lesions. In children, it appears more frequently in patients with acute myeloblastic leukemia (AML), particularly in subtypes with a monocytic component. Methods: We studied a retrospective cohort including all AML cases from the Hospital Infantil de México Federico Gómez between January 2009 to December 2019 and described the clinical characteristics of those who presented LC and other mucocutaneous manifestations. The information was collected from clinical records and analyzed using SPSS software (version 17). Results: We identified 54 AML cases: 53.7% were males, and 75.9% of the patients presented at least one dermatosis in the course of the disease. LC was clinically present in 14.8% of patients and was histologically confirmed in 9.2% of them; two congenital leukemia cases were identified. Among these patients, LC was more frequent in males. LC patients were younger than those without LC, the most frequent AML subtype was M2 (37.5%), and the most frequent clinical manifestations were plaques, chloromas, and gingival hyperplasia. None of the patients presented LC before AML diagnosis. Conclusions: Currently, only a few studies about LC on pediatric populations have been reported, and the existing ones have small sample sizes. We found clinical and epidemiological similarities with other populations in the studied sample.

Pearls and updates: cutaneous signs of systemic malignancy

“…Congenital leukemia, diagnosed before 6 weeks of age, has a 10–25% survival rate though spontaneous remission is possible in skin limited disease [4]. Though literature on LC is sparse with small sample sizes, data from the 3 most recent retrospective case series illustrate mortality rates of 12.5% ( n = 8), 38.7% ( n = 31), and 53% ( n = 24) in patients with LC [2,6 ▪ ]. Though not a component of official risk stratification, these data corroborate previous discussions of extramedullary skin involvement as a poor prognostic sign [5,11].…”

“…Although LC is typically diagnosed concurrently with a primary presentation of leukemia, it can also present as a sign of progressive or relapsed disease [2,10]. Additionally, isolated lesions, such as granulocytic sarcomas (aka chloromas), can rarely predate systemic involvement (known as aleukemic cutis) [2,3,6 ▪ ]. Staging and leukemia diagnosis requires further work up with complete blood counts, smear review and bone marrow aspiration.…”

“…A vesiculopustular eruption caused by a transient myeloproliferative disorder is reported in patients with trisomy 21 [5]. LC differs from other cutaneous signs of leukemia associated with hematologic dyscrasias including petechiae and ecchymoses, though these are often simultaneously identified on presentation and are valuable indicators of underlying disease [1,6 ▪ ]. The most common morphologic features of papules and nodules do not vary across different leukemic subtypes [2,6 ▪ ,7 ▪ ].…”

Chilblain-Like Eruption Unveiling Cutaneous Aleukemic Relapse of Acute Myeloid Leukemia

“…Acute leukemias are rapidly progressive systemic hematologic disorders with poor prognosis and decreased overall survival. 1,2 Skin involvement in acute leukemias divides into nonspecific and specific manifestations, depending on whether infiltrating leukemic cells are present in the skin lesions. 1,3,4 Leukemids or nonspecific skin lesions are those lesions that do not contain tumor cells and arise as a reactive manifestation to the presence of leukemia.…”

“…1,2 Skin involvement in acute leukemias divides into nonspecific and specific manifestations, depending on whether infiltrating leukemic cells are present in the skin lesions. 1,3,4 Leukemids or nonspecific skin lesions are those lesions that do not contain tumor cells and arise as a reactive manifestation to the presence of leukemia. Leukemia cutis (LC) corresponds to specific cutaneous infiltration by malignant hematopoietic cells into the epidermis, dermis, or subcutis.…”