Ominous cutaneous presentation of acute myeloid leukemia without peripheral blood involvement upon initial presentation and relapse: case report and literature review

Background: Aleukemic leukemia cutis (ALC) is an extremely rare cutaneous manifestation of an aggressive systemic hematological malignancy, associated with dermal infiltration by leukemic cells preceding peripheral blood involvement. This condition is associated with poor outcome, and dermatologists are often responsible for making the initial diagnosis in a timely fashion. Objectives: To describe a case of ALC and review the literature with an emphasis on the clinical features, summarizing the cutaneous manifestations of this rare systemic disorder. Materials and methods: Electronic searches were performed in PubMed and Embase for published studies and case reports in English from 1970 to 2017. Results: The presented case is a 46-year-old male with numerous asymptomatic skin-colored papules, plaques, and subcutaneous nodules with no detectable peripheral blood involvement, who was treated and subsequently relapsed twice with no evidence of peripheral blood or bone marrow involvement. Based on the review, skin nodules were the most common physical exam finding, comprising 27 cases (62.8%). The most common anatomic locations of cutaneous findings were the trunk and extremities, occurring in 23 (53.5%) and 20 (46.5%) cases, respectively. Conclusions: Since the cutaneous presentation of ALC is notably variable, a high degree of clinical suspicion is required. In view of this case and review of the literature, leukemia cutis should be included in the differential diagnosis of evolving, infiltrative cutaneous nodules or plaques, triggering an evaluation of the bone marrow and peripheral blood when the pathologic features raise concern for this disorder.