Pediatric leukemia cutis: A case series

Abstract

Background Pediatric leukemia cutis (LC) is often difficult to diagnose due to similarity in appearance to other dermatologic diseases. Several case reports and smaller case series have been published in the medical literature, but studies on larger cohorts of children with LC are lacking. Objective This study aimed to better characterize the clinical features, course, and prognosis of LC in the pediatric population. Methods We performed a retrospective case series of 31 patients diagnosed with LC at Boston Children's Hospital and the Children's Hospital of Philadelphia. Results The number and morphology of LC lesions varied among patients, with the head and lower extremities being the most common sites of involvement. Leukemia cutis presented concomitantly with systemic leukemia in the majority of cases. Most cases of LC arose during initial leukemia episodes, rather than with relapsed leukemia. Acute myeloid leukemia was the subtype most frequently associated with LC, followed by acute lymphoblastic leukemia. Diagnosis altered treatment timing and therapeutic decisions. Conclusion Children most often present concomitantly with LC and systemic leukemia. Since the morphology and distribution of LC varies, physicians must maintain a high index of suspicion for this diagnosis, as the presence of LC may change the management of systemic leukemia.

Leukemia cutis in a child with juvenile myelomonocytic leukemia presenting with Sweet syndrome–like lesions and a history of multiple juvenile xanthogranulomas

“…The median age at presentation is approximately 2 years, and lesions present commonly as erythematous-to-violaceous nodules or papules occurring on the head and lower limbs. 5 In our case, although the patient's clinical presentation was consistent with Sweet syndrome, there was absence of dense neutrophilic infiltrates within the dermis. Conversely, the infiltrate comprised atypical mononuclear cells more typical of infiltrates seen in JMML presenting with leukemia cutis.…”

Leukemia cutis mimicking tumid lupus as the presenting sign in a case of mixed T/B-cell acute lymphoblastic leukemia

“…However, LC may develop concurrently with other manifestations of acute leukemia or even precede the clinical detection of leukemia. 1 , 2 Because the clinical findings of LC are variable, histopathologic evaluation is essential for diagnosis. There are only rare reports of LC mimicking lupus erythematosus.…”

“…Leukemia cutis (LC) is rare and can have varying clinical and histopathologic presentations. 1 , 2 In acute lymphoblastic leukemia (ALL), LC has been reported in 1% to 3% of cases and usually after diagnosis, although it can present simultaneously, or even precede, the diagnosis of leukemia. 3 , 4 , 5 The clinical appearance of the leukemic infiltrate in the skin typically includes papules, plaques, and nodules and infrequently has mimicked inflammatory disorders.…”

Infant Acute Myeloid Leukemia: A Unique Clinical and Biological Entity

“…LC is commonly seen in FAB-4 and 5 AML [ 17 , 18 , 19 ]. Patients present with diffuse and papulonodular erythematous or violaceous skin lesions corresponding to leukemia infiltration into the epidermis, dermis or subcutaneous tissues [ 20 ].…”