Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Leukemia Cutis Mimicking Chilblains in Chronic Lymphocytic Leukemia
Description
This presentation described a 71-year-old woman with chronic lymphocytic leukemia (CLL) who developed persistent painful, violaceous toe lesions initially diagnosed as pernio after COVID infections, but biopsy revealed a dermal infiltrate of monomorphic lymphocytes consistent with leukemia cutis. A second case of painful toe lesions in a man with presumed relapsing polychondritis was similarly found to represent leukemia cutis, and review of an older ear biopsy suggested his ear disease had also been misdiagnosed. The talk reviewed CLL as a common adult mature B-cell neoplasm, usually indolent and often found incidentally, with leukemia cutis being rare in CLL and not necessarily a poor prognostic sign unless associated with Richter transformation. Typical skin findings in leukemia cutis include papules, plaques, or nodules, and in CLL the infiltrate is usually CD20, CD5, and CD23 positive with CD3 and cyclin D1 negative. The speaker emphasized that pernio-like lesions in older patients should not automatically be attributed to chilblains or COVID toes; biopsy and further workup are warranted, especially when lesions are persistent, atypical, or occur in the setting of hematologic disease.
View moreConclusions
- Chronic lymphocytic leukemia can rarely present in the skin and mimic pernio or chilblain lupus, so persistent toe lesions in older patients should not be assumed to be benign chilblains or COVID toes.
- Biopsy is essential when pernio-like lesions are atypical, worsening, chronic, or occur in older adults because the diagnostic histology may reveal leukemia cutis instead of an inflammatory pernio process.
- The skin findings in these cases represented leukemia cutis with a mature B-cell immunophenotype consistent with CLL/SLL, typically CD20+, CD5+, CD23+, CD3−, and cyclin D1−.
- Leukemia cutis in CLL is uncommon and, unlike leukemia cutis in many other leukemias, does not necessarily imply a poor prognosis.
- The cutaneous disease may improve when the underlying CLL is treated, as shown by resolution of the toe and ear lesions after systemic therapy.
- Leukemia cutis in CLL tends to occur late in the disease and is more common when Richter transformation is present, which is the situation most associated with worse outcomes.
- Pernio-like lesions in CLL may involve ears, toes, or the nose and can wax and wane or worsen with cold, making them easy to misclassify clinically.
- In elderly patients with new-onset pernio, clinicians should maintain a low threshold for broader systemic evaluation because such lesions can signal an underlying malignancy or other systemic disease.
- Smith A, et al. Br J Cancer 2011;105(11):1684-92.
- Siegel RL, et al. CA Cancer J Clin 2026;76(1):e70043
- Hallek and Robak.
- Parikh SA, et al. Cancer 2015;121(17):2883.
- Grandi V. et al. J Am Acad Dermatol 2019;81(1):246-249.
- Kang YS, et al. J Korean Med Sci 2013;28(4):614-9.
- Paydas S, et al. Br J Dermatol 2000;143:773-779.
- Acta Derm Venereol 2022.
- Robak E, et al. Cancers 2023;15(22):5393
- Cerroni L, et al. Am J Surg Path 1996;20(8):1000-10.
- Clinical and Experimental Dermatology, 2026.
- JAMA Dermatology, February 2021, Volume 157, Number 2.