Introduction:
Leukemia, also called blood cancer, is a highly malignant condition. It develops due to the growth of abnormal cells in the bone marrow. Malignant leukocyte cells are infiltrated into the bloodstream in leukemia, causing severe complications in individuals. Sometimes these malignant leukocytes penetrate the skin, causing “leukemia cutis,” a skin condition. It is a rare condition that depicts cancer at an advanced stage.
What Is Leukemia Cutis?
The word leukemia cutis is described as leukemia- blood cancer and cutis-thin outer layer of skin (skin under epidermis). Leukemia cutis is a rare skin condition that develops in leukemia-affected individuals. Leukemia cutis is triggered most commonly by acute myeloid leukemia (AML) and chronic myeloid leukemia (CML). It occurs due to the infiltration of malignant leukocyte cells from the bloodstream into the skin. They are characterized by the formation of patches or nodules or papules on the skin surface. Leukemia cutis is a suggestive sign of cancer progression into its advanced stage. Manifestation of leukemia cutis is also seen as a relapse in previously treated leukemia patients.
What Is Aleukemic Leukemia Cutis?
Aleukemic leukemia cutis is a rare condition where the malignant leukocytes (leukemic cells)invade the skin before the leukemic cells' observation in peripheral blood. It is often misdiagnosed as atypical lymphoma. Poor prognosis is seen in aleukemic leukemia cutis.
How Is Leukemia Cutis Caused?
Leukemia cutis is mainly caused by the infiltration of neoplastic leukocytes (leukemic cells) infiltration into the skin. It is only associated with leukemia and is not seen in individuals who are unaffected by leukemia. The exact reason why leukemic cells infiltrate the skin in leukemia patients is unknown. But some studies suggest that skin being a favorable environment for malignant transformation of leukocytes is the reason.
Some of the other predisposing risk factors causing leukemia cutis include
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Aneuploidy (occurrence of extra or missing chromosome leading to chromosomal abnormality) of chromosome 8.
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Lymphoproliferative disorders or myelodysplastic syndromes.
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Leukemia patients with existing skin complications.
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In children who are diagnosed with congenital leukemia.
What Are the Different Types of Leukemia That Are Associated With Leukemia Cutis?
The types of leukemia most commonly associated with leukemia cutis are:
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Myeloid leukemia, such as acute myeloid leukemia (AML) and chronic myeloid leukemia (CML).
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Chronic lymphocytic leukemia.
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T-cell lymphomas/ leukemia.
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Acute myelomonocytic leukemia (a specific subtype of AML).
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Congenital leukemia.
What Are the Symptoms of Leukemia Cutis?
Leukemia cutis is mostly seen in the legs and the surrounding skin area. It forms on the face, scalp, arms, and face. Lesions may either be generalized or localized, and it is usually painless. The varied changes seen in leukemia cutis include:
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Lesions appear either in the form of papules or nodules, or plaques on the skin surface.
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The color of the lesion exhibits characteristic red-brown or purple.
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Ulceration over the affected area is rarely seen.
Clinical features like bullae, ulcers, macules, and indurated or hemorrhagic plaques are seen less frequently in leukemia cutis.
Symptoms of leukemia are also seen along with leukemia cutis lesions. That include:
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Fever.
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Fatigue.
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Weight loss and loss of appetite.
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Bleeding.
How Is Leukemia Cutis Diagnosed?
To diagnose leukemia cutis, you should consult a dermatologist (one who treats skin disorders). A dermatologist may initially do a physical examination of the lesion to diagnose the condition. Followed by this, he may ask about your medical history to find out whether you are affected by leukemia or not. A biopsy may be suggested by a dermatologist to have a definitive diagnosis of the condition. Complete blood count tests will be suggested to detect the rise in white blood cells that helps in detecting leukemia.
All these diagnostic measures help in delineating leukemia cutis from other skin conditions caused by leukemia.
How Is Leukemia Cutis Treated?
Treating leukemia should be primarily done in managing leukemia cutis since leukemia is the underlying reason for leukemia cutis. The different treatment options for leukemia include:
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Radiation Therapy: Kills cancer cells using high-energy X-rays.
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Immunotherapy: A biological therapy that boosts the immune system of an individual using medicines to fight against cancer. It shows promising results in leukemia curing.
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Stem Cell Transplantation: The onset of leukemia mostly occurs in the bone marrow. In severe leukemia cases, there may be a requirement for stem cell transplantation (bone marrow transplant). This treatment modality will replace the cancer cells or damaged cells by chemotherapy or radiation therapy with healthy blood stem cells. However, due to certain constraints, this treatment approach is not possible in all leukemia patients. People who are already diagnosed with major health problems like kidney, lung, heart, or liver disease are not the ideal candidates for stem cell transplantation.
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Chemotherapy (Kills Cancer Cells Using Drugs): Systemic treatment of leukemia is the first-line treatment in treating leukemia cutis condition. Treating only leukemia cutis cannot cure the condition, so both systemic treatment of leukemia and treating leukemia cutis lesions should be done together. The different treatments done to treat leukemia cutis lesions include:
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Medications: Topical medications like steroid creams, topical Lidocaine, mentholated lotions, and topical Retinoids are used in treating leukemia cutis lesions. These are used to relieve the pain and other symptoms like swelling.
Antimicrobial medications are used to prevent any infection over the leukemia cutis lesion.
The other treatments include phototherapy, and electron beam therapy, that help in reducing the size of skin lesions.
Is Leukemia Cutis Fatal?
Leukemia cutis itself is not a fatal condition. However, leukemia being the underlying reason can make leukemia cutis highly fatal. Leukemia cutis is an alarming sign that indicates cancer has progressed into the advanced stage.
Does Leukemia Cutis Go Away on Its Own?
No, leukemia cutis does not regress on its own. Leukemia cutis only resolve if the leukemia treatment provides effective results. Treating only leukemia cutis lesions will not cure it; however, treating leukemia effectively helps in curing leukemia cutis.
Conclusion:
Leukemia cutis is a rare condition that occurs in association with leukemia. It is a suggestive sign of leukemia being progressed into an advanced stage. It is caused by the infiltration of neoplastic leukocytes into the skin. Treating leukemia cutis is done primarily by treating leukemia which is the underlying cause of leukemia cutis. People diagnosed with leukemia are at high risk of developing leukemia cutis. Do consult a dermatologist if you are diagnosed with leukemia cutis.
