Leukemic penile ulcer as the presenting symptom of chronic lymphatic leukemia

Chronic lymphatic leukemia (CLL) is the most common type of leukemia in the West, with an incidence of 4.2 per 100 000 population. Penile prepuce involvement at presentation, as the first manifestation of CLL, is extremely rare. We have seen a 69-year-old male patient who presented with a non-healing ulcer on the foreskin of the penis for 6 weeks. Biopsy revealed the diagnosis of small lymphocytic lymphoma. His hematological work-up uncovered an underlying CLL. He was treated with acalabrutinib, a Bruton tyrosine kinase inhibitor, resulting in complete remission after 7 weeks. In the vast majority of patients with CLL, the disease primarily involves bone marrow, peripheral blood, lymph nodes, and spleen; extramedullary and extranodal involvement is rarely seen. This case highlights the importance of keeping leukemic involvement into consideration in patients with penile lesions, as it can be the first manifestation of underlying CLL.