Summary about Disease
Leukemia cutis (LC) is the infiltration of the skin by leukemic cells, resulting in clinically diverse cutaneous lesions. It can occur at any stage of leukemia, including before, during, or after the diagnosis of systemic leukemia. LC is most commonly associated with acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML). The lesions can vary greatly in appearance, making diagnosis challenging. While it's a skin manifestation of leukemia, it's not a primary skin cancer.
Symptoms
The symptoms of leukemia cutis are primarily skin lesions. These can present in various forms:
Papules: Small, raised bumps
Nodules: Larger, solid lumps under the skin
Plaques: Flat, raised areas of skin
Macules: Flat, discolored spots
Ulcers: Open sores
Erythema: Redness of the skin
Purpura: Small red or purple spots caused by bleeding under the skin
Blisters: Fluid-filled sacs The lesions can be single or multiple, localized or widespread, and may be itchy or painless. They can appear anywhere on the body but are often found on the trunk, extremities, and face.
Causes
Leukemia cutis is caused by leukemic cells migrating from the bone marrow (or other sites of leukemia) and infiltrating the skin. The exact mechanisms that cause this migration are not fully understood, but it involves complex interactions between the leukemic cells, the skin microenvironment, and adhesion molecules.
Medicine Used
Treatment for leukemia cutis primarily focuses on treating the underlying systemic leukemia. Specific medications used vary depending on the type of leukemia, but commonly include:
Chemotherapy: Cytarabine, daunorubicin, idarubicin, fludarabine, cladribine, etc.
Targeted therapy: Medications targeting specific mutations in leukemia cells (e.g., FLT3 inhibitors, IDH inhibitors)
Immunotherapy: Blinatumomab, gemtuzumab ozogamicin
Stem cell transplantation: In some cases, a hematopoietic stem cell transplant may be considered. Local treatments for skin lesions include:
Topical corticosteroids: To reduce inflammation and itching.
Radiation therapy: To target and destroy leukemic cells in the skin lesions.
Electron beam therapy: Another form of radiation therapy.
Surgical excision: In some cases, lesions may be surgically removed.
Is Communicable
Leukemia cutis is not communicable. It is not an infectious disease and cannot be spread from person to person through any means (e.g., contact, air, bodily fluids).
Precautions
Precautions related to leukemia cutis are primarily focused on managing the underlying leukemia and its complications. These include:
Avoiding infections: Due to immune suppression from leukemia and/or treatment. This includes frequent handwashing, avoiding close contact with sick people, and receiving recommended vaccinations (after consulting with a doctor).
Monitoring for bleeding: Leukemia can affect blood clotting. Report any unusual bleeding or bruising to your doctor.
Skin care: Protect skin lesions from infection and irritation.
Following treatment plan: Adhere strictly to the treatment plan prescribed by your oncologist.
Managing side effects: Be aware of and manage potential side effects of leukemia treatment (e.g., nausea, fatigue, hair loss).
How long does an outbreak last?
The duration of a leukemia cutis "outbreak" (i.e., the presence of skin lesions) is highly variable. It depends on factors such as:
The type and severity of the underlying leukemia.
The effectiveness of treatment for the leukemia.
The specific treatments used for the skin lesions.
The individual's overall health and response to treatment. Lesions may resolve with successful treatment of the underlying leukemia, but they can also persist, recur, or progress even during systemic therapy.
How is it diagnosed?
Leukemia cutis is diagnosed through a combination of:
Clinical examination: Examination of the skin lesions and medical history.
Skin biopsy: A sample of the skin lesion is taken and examined under a microscope to identify leukemic cells.
Immunohistochemistry: Special stains are used on the biopsy sample to identify specific markers on the leukemic cells, helping to determine their origin and type.
Flow cytometry: This technique can be used on skin biopsy samples or bone marrow aspirates to identify and characterize leukemic cells.
Bone marrow biopsy: To assess the status of the underlying leukemia.
Complete blood count (CBC): To evaluate blood cell levels and identify any abnormalities.
Timeline of Symptoms
The timeline of leukemia cutis symptoms is highly variable and depends on the individual and the progression of their underlying leukemia.
Onset: Skin lesions can appear before, during, or after the diagnosis of systemic leukemia.
Progression: Lesions may develop gradually or rapidly. They can start as small, isolated spots and then spread or coalesce into larger areas.
Resolution: With effective treatment of the underlying leukemia, the skin lesions may resolve. However, they can also persist, recur, or progress even during systemic therapy. It is important to note that this is a general timeline, and the actual course of the disease can vary significantly.
Important Considerations
Leukemia cutis is a sign of systemic disease and should be evaluated by a hematologist/oncologist.
The prognosis for leukemia cutis depends on the type and stage of the underlying leukemia, as well as the response to treatment.
Early diagnosis and treatment of the underlying leukemia are crucial for improving outcomes.
Patients with leukemia cutis should be closely monitored for signs of disease progression or recurrence.
Palliative care may be necessary to manage symptoms and improve quality of life.
Because LC can mimic other skin conditions, diagnosis can sometimes be delayed. High clinical suspicion is needed, especially in patients with known leukemia or suggestive hematologic abnormalities.