Leukemia Cutis as an Early Presentation or Relapsing Manifestation of Chronic Lymphocytic Leukemia (CLL) Leukemia Cutis in Chronic Lymphocytic Leukemia

Main Article Content

Mahmood B. Aldapt
Mohamed Yassin


CLL Leukemia Cutis skin Manifestations


Background and Objective: Cutaneous infiltration by Chronic Lymphocytic Leukemia (CLL) is a rare complication. The clinical presentation, impact of it on disease prognosis, and the proper treatment choice are not clear. Here in our review, we try to answer these questions. Acquisition of evidences: A systematic search of PubMed, and Google Scholar for English language articles published from Jan 2000 to June 2019. Synthesis of evidences: A total of 56 cases were identified, with a median age of 66 years. Of these cases 43 were males and 12 were females, and one missing data, with a ratio of 3,6:1. Head and neck were most commonly involved. The commonest clinical presentation was papulonodular lesions, and the majority were diagnosed at an early stage. CLL skin involvement at the site of old herpetic lesions was common. Because of the rarity of the disease, treatment modalities varied widely, and there are no consensus on treatment. The majority were treated with chemotherapy. In general, 35 (77.8% - of the non-missing data) patients responded to treatment (25 patients had a complete remission and 10 a partial remission). All patients ≤60 years had an early-stage disease, on the other hand, all patients with advanced-stage were >60 years. Conclusion: Patients with early-stage and localized leukemia cutis can benefit from observation alone strategy, while intervention in young patients with advanced disease is warranted. Skin infiltration by CLL does not affect prognosis, as most patients attained complete or partial remission with a very low progression rate.


Download data is not yet available.
Abstract 13 |


1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. Cancer J Clin. 2014;64:9‐29.
2. Rozman C, Montserrat E. Chronic lymphocytic leukemia. N Engl J Med. 1995; 333: 1052‐1057.
3. Nabhan C, Rosen ST. Chronic lymphocytic leukemia: a clinical review. JAMA. 2014;312:2265‐2276.
4. Greenwood R, Barker DJ, Tring FC, et al. Clinical and immunohistological characterization of cutaneous lesions in chronic lymphocytic leukaemia. Br J Dermatol. 1985;113:447‐453.
5. Cerroni L, Zenahlik P, Höfler G, Kaddu S, Smolle J, Kerl H. Specific cutaneous infiltrates of B-cell chronic lymphocytic leukemia: a clinicopathologic and prognostic study of 42 patients. Am J Surg Pathol. 1996;20:1000‐1010.

6. Stawiski MA. Skin manifestations of leukemias and lymphomas. Cutis. 1978;21: 814 ‐818.
7. Colburn DE, Welch MA, Giles FJ. Skin infiltration with chronic lymphocytic leukemia is consistent with a good prognosis. Hematology. 2002;7:187‐188.
8. Ali L, Cheney R, Merzianu M. Subclinical chronic lymphocytic leukemia with atypical cutaneous presentation. J Cutan Pathol. 2011;38:236-40.
9. Sokumbi O, Gibson LE, Comfere NI, Peters MS. Granuloma annulare-like eruption associated with B-cell chronic lymphocytic leukemia. J Cutan Pathol. 2012;39:996-1003.
10. Tuba B, Üsküdar TH, Eda T, Neslihan A, Eren G, Deniz A. A Rare Involvement Region in a Patient with B-Cell Chronic Lymphocytic Leukemia: Skin. Advances Leuk Res Treat. 2017;1:20-22.
11. Fulton E, Alapat D, Mabry A, Gao L, Shalin SC. CLL/SLL with initial presentation as a longstanding cutaneous plaque: a rare case. J Cutan Pathol. 2016;43:717-721.
12. Singh A, Graziano S, Vajpayee N. Biclonal chronic lymphocytic leukemia presenting as skin lesion. Am J Dermatopathol. 2014;36:260-262.
13. Jasim ZF, Cooke N, Somerville JE, Hay RJ. Chronic lymphocytic leukaemia skin infiltrates affecting prominent parts of the face and the scalp. Br J Dermatol. 2006;154:981‐982.
14. Lu C, Li L, Qiao Q, Liu G, Fang L. Cutaneous manifestations in a patient with chronic lymphocytic leukemia involving the head, neck and distal extremities. Exp Ther Med. 2015;9:877‐879.

15. Snorek M, Bulava A, Vonke I. Chronic lymphocytic leukemia skin infiltration mimicking an ICD pocket infection: a case report. BMC Cardiovasc Disord. 2017 Mar 24;17(1):89. doi: 10.1186/s12872-017-0522-5.
16. Kazakov DV, Belousova IE, Michaelis S, Palmedo G, Samtsov AV, Kempf W. Unusual manifestation of specific cutaneous involvement by B-cell chronic lymphocytic leukemia: spontaneous regression with scar formation. Dermatology. 2003; 207: 111 ‐115.
17. Robak E, Robak T, Biernat W, Bartkowiak J, Krykowski E. Successful treatment of leukaemia cutis with cladribine in a patient with B-cell chronic lymphocytic leukaemia. Br J Dermatol. 2002;147:775‐780.
18. Ural AU, Kubar A, Avcu F, et al. Oral fludarabine treatment of cutaneous infiltration in a patient with B-cell chronic lymphocytic leukaemia. Clin Exp Dermatol. 2007; 32: 151 ‐154.
19. Hapgood G, Mooney E, Dinh HV, Gin D, McLean C, Ting SB. Leukaemia cutis in chronic lymphocytic leukaemia following varicella zoster virus reactivation. Intern Med J. 2012;42:1355-1358.
20. Plaza JA, Comfere NI, Gibson LE, et al. Unusual cutaneous manifestations of B-cell chronic lymphocytic leukemia. J Am Acad Dermatol. 2009;60:772-780.
21. Barzilai A, Feuerman H, Quaglino P, et al. Cutaneous B-cell neoplasms mimicking granulomatous rosacea or rhinophyma. Arch Dermatol. 2012;148:824‐831.

22. Gibbs SD, Westerman DA, Lade S, McCormack C, Seymour JF, Prince HM. Early B-cell chronic lymphocytic leukemia presenting as cutaneous lesions with a normal peripheral blood lymphocyte count. J Am Acad Dermatol. 2005;53:535‐536.
23. Stefanidou MP, Kanavaros PE, Tosca AD. Chronic lymphocytic leukemia presenting as cutaneous and bone involvement. Int J Dermatol. 2001;40:50‐52.
24. Ziemer M, Bornkessel A, Hahnfeld S, Weyers W. 'Specific' cutaneous infiltrate of B-cell chronic lymphocytic leukemia at the site of a florid herpes simplex infection. J Cutan Pathol. 2005;32:581‐584.
25. Yağci M, Sucak GT, Haznedar R. Red swollen nail folds and nail deformity as presenting findings in chronic lymphocytic leukaemia. Br J Haematol. 2001;112(1):1. doi:10.1046/j. 1365-2141.2001.02650.x.
26. Antunes J, Pacheco D, Travassos R, Filipe P. Zosteriform B-cell chronic lymphocytic leukemia infiltration. Dermatol Online J. 2011;17(9):9.
27. Raufi A, Alsharedi M, Khelfa Y, Griswold DC, Lebowicz Y. Leukemia cutis in a patient with chronic lymphocytic leukemia presenting as bilateral helical nodules. SAGE Open Med Case Rep. 2016 Dec 1;4:2050313X16683624. doi: 10.1177/2050313X16683624.
28. Bekel L, Dhaille F, Chaby G, et al. An unusual cutaneous of B-cell chronic lymphocytic leukemia presenting as a massive left-sided body ecchymosis. JAAD Case Rep. 2015;1:49–50.
29. Atwal D, Raval M, Firwana B, Ramos J, Sasapu A. An unusual presentation of chronic lymphocytic leukemia. Avicenna J Med. 2017;7:133–136.

30. Blixt EK, Brewer JD. Chronic lymphocytic leukemia: cutaneous involvement associated with nodular amyloidosis. Int J Dermatol. 2015 Jun;54(6):e230-2. doi: 10.1111/ijd.12202.
31. Caldato Lde S, Britto Jde S, Niero-Melo L, Miot HA. Bullous leukemia cutis mimicking facial cellulitis. An Bras Dermatol. 2016;91:248–249.
32. Mawri S, Nabi S, Jallad B, Won J. Leukaemia cutis after starting bendamustine: cause or coincidence? BMJ Case Rep. 2015 Sep 21;2015:bcr2014209025. doi: 10.1136/bcr-2014-209025.
33. di Meo N, Stinco G, Trevisan G. Cutaneous B-cell chronic lymphocytic leukaemia resembling a granulomatous rosacea. Dermatol Online J. 2013;19(10):20033.
34. Walker JL, Cohen LM, Kroumpouzos G. Bilateral auricular involvement: a rare presenting sign of chronic lymphocytic leukemia, and successful treatment with electron beam therapy. Acta Derm Venereol. 2015;95:616-617.
35. Ikeda T, Sakurane M, Uede K, Furukawa F. A case of symmetrical leukemia cutis on the eyelids complicated by B-cell chronic lymphocytic lymphoma. J Dermatol. 2004;31:560‐563.
36. Caravaglio J, Wheatley R, Orban M, Greenwald J. A case of leukemia cutis presenting as blue toes in a patient with chronic lymphocytic leukemia. JAAD Case Rep. 2016;2:186–188.
37. Genovese G, Nazzaro G, Alberti Violetti S, Passoni E, Berti E. Rosacea-like cutaneous localization of small lymphocytic lymphoma unmasked by high-frequency-ultrasound. Skin Res Technol. 2018;24:701-703.

38. Tram Do B, Charpentier AM, Bourré-Tessier J, Maietta A, Doucet S, Ayad T, Christopoulos A. Unusual presentation for small lymphocytic lymphoma: Case report of a man with bilateral ear involvement and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136:S45-S47.
39. Stang K, Alite F, Steber J, Emami B, Surucu M. Leukemia Cutis of the Face, Scalp, and Neck Treated with Non-coplanar Split Field Volumetric Modulated Arc Therapy: A Case Report. Cureus. 2015;7(12):e430. Published 2015 Dec 23. doi:10.7759/cureus.430
40. Anyfantakis V, Dammak A, Wierzbicka-Hainaut E, et al. Efficacy of intralesional methotrexate in specific cutaneous involvement of B-cell chronic lymphocytic leukaemia. J Eur Acad Dermatol Venereol. 2010 Jul;24(7):856. doi: 10.1111/j.1468-3083.2009.03510.x.
41. Garcia-Cruz A, Feal Cortizas C, Posada Garcia C, Dios Loureiro A, Carpintero Saiz L, Cruces Prado M. Genital ulcer in a patient with chronic lymphocytic leukaemia. Clin Exp Dermatol. 2011;36:107‐109.
42. Porter WM, Sidwell RU, Catovsky D, Bunker CB. Cutaneous presentation of chronic lymphatic leukaemia and response to ultraviolet B phototherapy. Br J Dermatol. 2001;144:1092‐1094.
43. Spaner DE, Miller RL, Mena J, Grossman L, Sorrenti V, Shi Y. Regression of lymphomatous skin deposits in a chronic lymphocytic leukemia patient treated with the Toll-like receptor-7/8 agonist, imiquimod. Leuk Lymphoma. 2005;46:935‐939.

44. Murad A, Fortune A, O' Keane C, Ralph N. Granulomatous rosacea-like facial eruption in an elderly man: leukaemia cutis. BMJ Case Rep. 2016 Apr 26;2016:bcr2016215568. doi: 10.1136/bcr-2016-215568.
45. Ng E, Patel V, Engler D, Grossman M. Chronic lymphocytic leukemia associated leukemia cutis presenting as acne rosacea. Leuk Lymphoma. 2012;53:2304-2306.
46. Tapia G, Mate JL, Fuente MJ, et al. Cutaneous presentation of chronic lymphocytic leukemia as unique extramedullar involvement in a patient with normal peripheral blood lymphocyte count (monoclonal B-cell lymphocytosis). J Cutan Pathol. 2013;40 :740 ‐744.
47. Kindem S, Traves V, Requena C, et al. Bilateral cauliflower ear as the presenting sign of B-cell chronic lymphocytic leukemia. J Cutan Pathol. 2014;41:73‐77.
48. Kakagia D, Tamiolakis D, Lambropoulou M, Kakagia A, Grekou A, Papadopoulos N. Systemic B-cell chronic lymphocytic leukemia first presenting as a cutaneous infiltrate arising at the site of a herpes simplex scar. Minerva Stomatol. 2005;54:161‐163..
49. Rosman IS, Nunley KS, Lu D. Leukemia cutis in B-cell chronic lymphocytic leukemia presenting as an episodic papulovesicular eruption. Dermatol Online J. 2011;17(9):7.
50. Freiman A, Muhn CY, Trudel M, Billick RC. Leukemia cutis presenting with fingertip hypertrophy. J Cutan Med Surg. 2003;7:57‐60.
51. Kash N, Fink-Puches R, Cerroni L. Cutaneous manifestations of B-cell chronic lymphocytic leukemia associated with Borrelia burgdorferi infection showing a marginal zone B-cell lymphoma-like infiltrate. Am J Dermatopathol. 2011;33:712-715.

52. Sarpal A, Loghdey S, Lister R. Asymptomatic papules in a patient with chronic lymphocytic leukaemia. Isotopic leukaemia cutis. Clin Exp Dermatol. 2010;35:563‐564.
53. Watson KM, Mufti G, Salisbury JR, du Vivier AW, Creamer D. Spectrum of clinical presentation, treatment and prognosis in a series of eight patients with leukaemia cutis. Clin Exp Dermatol. 2006;31:218‐221.
54. Wollina U, Schönlebe J. Disseminated specific cutaneous infiltrates of B-cell chronic lymphocytic leukemia - Wolf's isotopic response following herpes zoster infection. J Dtsch Dermatol Ges. 2016;14:179‐181.
55. Paul K, Paul G, Kazal HL, Bairwa NK. An Unusual Presentation of Chronic Lymphocytic Leukaemia. J Clin Diagn Res. 2015;9(8):OJ01. doi:10.7860/ JCDR/ 2015/14326.6391
56. Schmults CA. Leukemia cutis (chronic lymphocytic leukemia-low grade B cell). Dermatol Online J. 2002;8(2):14.
57. Robak E, Robak T. Skin lesions in chronic lymphocytic leukemia. Leuk Lymphoma. 2007;48:855‐865.
58. Agnew KL, Ruchlemer R, Catovsky D, Matutes E, Bunker CB. Cutaneous findings in chronic lymphocytic leukaemia. Br J Dermatol. 2004;150:1129‐1135.
59. Sah A, Barrans SL, Parapia LA, Jack AS, Owen RG. Cutaneous B-cell lymphoma: pathological spectrum and clinical outcome in 51 consecutive patients. Am J Hematol. 2004;75:195‐199.

60. Cerroni L, Höfler G, Bäck B, Wolf P, Maier G, Kerl H. Specific cutaneous infiltrates of B-cell chronic lymphocytic leukemia (B-CLL) at sites typical for Borrelia burgdorferi infection. J Cutan Pathol. 2002;29:142‐147.
61. Thiesen I, Wehkamp U, Brüggemann M, et al. Skin involvement by chronic lymphocytic leukaemia is frequently associated with unrelated neoplastic or inflammatory cutaneous disease and is not indicative of general disease progression. Br J Dermatol. 2019;180:227‐228.