Leukemia cutis (LC) is an uncommon cutaneous manifestation of leukemia that involves the leukocytic infiltration of the skin. LC typically presents after a diagnosis of leukemia has been made but may rarely appear before confirmation of the disease. In this report, we describe the case of an 86-year-old male presenting with LC prior to a clear diagnosis of leukemia in the blood. This case highlights the importance of early recognition of LC lesions, to ensure earlier detection of the neoplasm, particularly when they present as the first sign of disease.