Skin involvement in chronic myelomonocytic leukaemia as a predictor of transformation into acute myeloid leukaemia

Abstract

We report on the case of a patient with myelodysplastic syndrome (MDS) who presented with leukaemia cutis preceding development of acute myeloid leukaemia. Leukaemic infiltration of the skin should be considered an early manifestation of leukaemic transformation and an indicator of poor prognosis in MDS.

Cutaneous manifestations in relation to immunologic parameters in a cohort of primary myelodysplastic syndrome patients

“…Specific lesions are uncommon and are characterized by the presence of neoplastic cells in the skin. They are referred to as leukaemia cutis, are indicative of blastic transformation of MDS and carry a grim prognosis 8,9 . In contrast, non‐specific lesions are common, lack skin infiltration by neoplastic cells and generally they do not affect prognosis 10 .…”

Specific cutaneous involvement of a mixed-type mature plasmacytoid dendritic cell tumor in chronic myelomonocytic leukemia

“…The specific cutaneous lesions of CMML are seen very rarely with a prevalence of 10%. In some cases, CMML can be transformed to acute myeloid leukemia that is also accompanied by the lesions of myeloid leukemia cutis 9 . Vitte et al 10 reported four different clinicopathological subtypes of cutaneous involvement in CMML with different prognostic courses; myelomonocytic cell tumor, MPDCT, blastic PDCT (BPDCT) and blastic indeterminate dendritic cell tumor (BIDCT).…”

“…The differential diagnosis of a leukemic skin lesion located on the trunk includes a vast majority of cutaneous diseases, such as cutaneous malignancies, metastasis of visceral malignancies, Kaposi sarcoma, drug eruption, viral exanthem, syphilitic exanthem, pityriasis rosea, urticarial vasculitis, Sweet's syndrome, cutaneous pseudolymphoma, and cutaneous lymphomas 2 . Chronic myelomonocytic leukemia (CMML) is characterized by an absolute monocytosis greater than 1x10 9 /L in the peripheral blood that persists for at least three months. greater than 1x10 9 /L in the peripheral blood that persists for at least three months.…”

Cutaneous leukaemic infiltrations in a patient with previously undiagnosed myelodysplastic syndrome

“…So far, leukaemia cutis as a herald sign of a transformation of RAEB has been reported only sporadically 5,6 . However, it is known from cases with chronic myelomonocytic leukaemia, another subtype of MDS, that leukaemic transformation in MDS patients is not infrequently accompanied by skin infiltrations 7,8 …”