Leukemia cutis treated with total skin irradiation

Area of Science:

• Pediatric Oncology
• Hematology
• Leukemia Research

Background:

• Acute monoblastic leukemia (AML) is a rare and aggressive form of leukemia.
• Extramedullary involvement, including skin and central nervous system, can occur in infant AML.
• Treatment of relapsed infant AML presents significant challenges.

Observation:

• A case report of an infant diagnosed with acute monoblastic leukemia presenting with extramedullary disease (skin, bone marrow, cerebrospinal fluid).
• Following initial remission, the patient experienced an isolated relapse confined to the skin.
• The patient received superficial electron beam irradiation to the entire skin surface for the relapse.

Findings:

• The patient achieved and maintained remission for 12 months post-treatment with total skin electron beam irradiation.
• The isolated nature of the skin relapse, without involvement of previously irradiated areas, supports a unique behavior of leukemic cells.
• Cytogenetic data provided further evidence for the hypothesis that leukemic cells may have persisted in the skin since diagnosis.

Implications:

• This case highlights the potential for isolated skin relapse in infant acute monoblastic leukemia.
• Total skin electron beam irradiation may be an effective therapeutic strategy for isolated cutaneous relapse.
• The findings suggest the skin may act as a sanctuary site for leukemic cells, warranting further investigation into its role in disease persistence and relapse.