Skin lesions in chronic lymphocytic leukemia

Area of Science:

• Dermatology
• Hematology
• Oncology

Background:

• Cutaneous lesions affect up to 25% of chronic lymphocytic leukemia (CLL) patients.
• Lesions can stem from leukemic cell infiltration (leukemia cutis) or nonmalignant disorders.
• Secondary cutaneous malignancies, particularly skin cancer, are more frequent in CLL patients.

Purpose of the Study:

• To review the spectrum of cutaneous manifestations in chronic lymphocytic leukemia (CLL).
• To discuss the prognostic implications of leukemia cutis and secondary malignancies in CLL.
• To highlight the diverse range of nonmalignant skin changes observed in CLL patients.

Main Methods:

• Review of existing literature on cutaneous lesions in CLL.
• Analysis of clinical presentations and prognostic factors.
• Categorization of lesions into leukemic infiltration, secondary malignancies, and nonmalignant disorders.

Main Results:

• Leukemia cutis in CLL typically presents as papules, plaques, or nodules.
• Prognosis for CLL with leukemia cutis is generally good, but poor if blastic transformation (Richter's syndrome) occurs.
• Secondary skin cancers are significantly increased in CLL patients, potentially linked to treatments like alkylating agents and purine analogs.
• Common nonmalignant lesions include infectious or hemorrhagic changes, vasculitis, pruritus, erythroderma, and paraneoplastic pemphigus.

Conclusions:

• Cutaneous manifestations in CLL are diverse, ranging from direct leukemic infiltration to secondary malignancies and nonmalignant conditions.
• Early recognition and management of specific skin lesions are crucial for patient outcomes.
• The increased risk of secondary skin cancers warrants vigilant surveillance and potentially modified treatment strategies in CLL patients.