Leukemia cutis

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Leukemia cutis
Specialty Dermatology

Leukemia cutis is the infiltration of neoplastic leukocytes or their precursors into the skin resulting in clinically identifiable cutaneous lesions. [1] This condition may be contrasted with leukemids, which are skin lesions that occur with leukemia, but which are not related to leukemic cell infiltration. [1] [2] Leukemia cutis can occur in most forms of leukemia, including chronic myeloid leukemia, acute lymphoblastic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and prolymphocytic leukemia. [3]

Contents

Aleukemic leukemia cutis occurs when cancerous white blood cells penetrate the skin before they are detected in the bone marrow or peripheral circulation. [4]

Signs and symptoms

The clinical appearance of leukemia cutis varies, with the most common lesions being erythematous to violaceous papules or nodules (60%), followed by infiltrating plaques, generalized cutaneous eruption, and erythroderma. [5] Oftentimes, they have no symptoms. [6] Usually having a solid or rubbery consistency, the nodules might turn purpuric in patients who are thrombocytopenic. [5]

Unusual presentations include those that resemble ulcers, stasis dermatitis, guttate psoriasis, and figurate erythemas. Leukemia cutis has also been reported to localize to injuries, intravenous catheters, herpes lesions, and recent surgical procedures. [5]

Causes

Leukemia cutis may develop concurrently with the diagnosis of systemic leukemia, come first, or come later. Most cases of leukemia cutis occur in the context of an existing leukemia (44–77%) or at the time of systemic leukemia presentation (23–44%). [5] On rare occasions, leukemia cutis may occur before leukemia in the bone marrow or peripheral blood becomes observable. [7]

Leukemia cutis is linked to a number of gene abnormalities, such as chromosome 8 numerical anomalies, translocation (8; 21) (q22; q22), and inversion (16) (p13; q22). [8] [9]

Mechanism

Leukemic skin involvement's pathogenic mechanism is poorly understood. [10] Nonetheless, it's thought that chemokine receptors, adhesion molecules, and the genetic features of leukemia all have an impact. [11] Adhesion molecules, specifically chemokine integrin, may have a role in the migration of leukemic cells into the skin through processes known as skin-selective homing. [12] [13] Adhesion molecules and chemokine receptors may also have significant effects. On the dermal post-capillary venules, TARC (thymus- and activation-regulated chemokine)/CCL17 (CC chemokine ligand 17) and/or E-selectin may interact with the cutaneous leucocyte-associated antigen (CLA) receptor and CC chemokine receptor 4 (CCR4) on the leukemic cells. Leukemic cell migration and binding into the dermis may be facilitated by this process. Additionally, integrins and endothelial-bound chemokines may interact to promote leukemic cell migration into the dermis. [10]

Diagnosis

Leukemia cutis is diagnosed by looking at the morphologic pattern of skin infiltration, cytologic characteristics, and most importantly the tumor cells' immunophenotype. The diagnosis is frequently confirmed by correlation with peripheral blood and bone marrow results as well as clinical data. [11]

Treatment

Leukemia cutis is a localized symptom of a systemic underlying disease that requires systemic therapy tailored to the individual subtype of leukemia. Hematologic remission typically happens in tandem with a full or partial response to cutaneous infiltrations in the majority of individuals. [10] Local radiotherapy, however, may be employed in patients with resistant leukemia cutis or recurrent skin infiltration. [14] The treatment of refractory cutaneous leukemia has led to the proposal of simultaneous integrated boost with helical arc radiotherapy of total skin (HEARTS) for cutaneous symptoms. [15]

Outlook

The prognosis is poor, with many patients suffering from additional extramedullary diseases and low survival rates. Most patients pass away months after being diagnosed. Patients without skin lesions who have acute myelogenous leukemia had a 30% survival rate after two years, but those with skin lesions have a 6% survival rate, which indicates an unfavorable prognosis for leukemia cutis. [5]

Epidemiology

Leukemia cutis can occur anywhere between 2% and 30% of the time, depending on the underlying leukemia diagnosis. [10]

See also

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References

  1. 1 2 James, William Daniel; Berger, Timothy G.; Elston, Dirk M. (2006). Andrews' Diseases of the Skin: clinical Dermatology . Saunders Elsevier. pp.  744–5. ISBN   978-0-7216-2921-6.
  2. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1892. ISBN   978-1-4160-2999-1.
  3. ↑ Leukemia Cutis at eMedicine
  4. ↑ Du, Amy X; Hung, Tawny; Surmanowicz, Philip; Gniadecki, Robert (2020). "Diagnostic challenge of aleukemic leukemia cutis preceding acute myelogenous leukemia: A case report". SAGE Open Medical Case Reports. 8. SAGE Publications: 2050313X2091963. doi:10.1177/2050313x20919638. ISSN   2050-313X. PMC   7233898 .
  5. 1 2 3 4 5 Rao, AngooriG; Danturty, Indira (2012). "Leukemia cutis". Indian Journal of Dermatology. 57 (6). Medknow: 504. doi: 10.4103/0019-5154.103086 . ISSN   0019-5154. PMC   3519272 . PMID   23248383.
  6. ↑ Koizumi, Hiroko; Kumakiri, Masanobu; Ishizuka, Midori; Ohkawara, Akira; Okabe, Sanehiro (1991). "Leukemia Cutis in Acute Myelomonocytic Leukemia: Infiltration to Minor Traumas and Scars". The Journal of Dermatology. 18 (5). Wiley: 281–285. doi:10.1111/j.1346-8138.1991.tb03083.x. ISSN   0385-2407. PMID   1939854. S2CID   19558080.
  7. ↑ Yones, SS; Khorasgani, MG; Iqbal, T; Arrifin, N; Mehta, R; Skibinska, G; Karim, A; Grech, C; Ivanov, G; Khorshid, M (December 2009). "Aleukemic leukemia cutis" (PDF). Egyptian Dermatology Online Journal. 5 (2). Retrieved 9 March 2024.
  8. ↑ Agis, H.; Weltermann, A.; Fonatsch, C.; Haas, O.; Mitterbauer, G.; Müllauer, L.; Schreiber, S.; Schwarzinger, I.; Juretzka, W.; Valent, P.; Jäger, U.; Lechner, K.; Geissler, K. (2002-01-23). "A comparative study on demographic, hematological, and cytogenetic findings and prognosis in acute myeloid leukemia with and without leukemia cutis". Annals of Hematology. 81 (2). Springer Science and Business Media LLC: 90–95. doi:10.1007/s00277-001-0412-9. ISSN   0939-5555. PMID   11907789. S2CID   9364519.
  9. ↑ Kubonishi, Ichiro; Seto, Masao; Murata, Naoaki; Kamioka, Mikio; Taguchi, Hirokuni; Miyoshi, Iaso (1998). "Translocation (10;11)(p13;q13) and MLL Gene Rearrangement in a Case of AML (M5a) with Aggressive Leukemia Cutis". Cancer Genetics and Cytogenetics. 104 (1). Elsevier BV: 28–31. doi:10.1016/s0165-4608(97)00414-7. ISSN   0165-4608. PMID   9648554.
  10. 1 2 3 4 Robak, Ewa; Braun, Marcin; Robak, Tadeusz (2023-11-13). "Leukemia Cutis—The Current View on Pathogenesis, Diagnosis, and Treatment". Cancers. 15 (22). MDPI AG: 5393. doi: 10.3390/cancers15225393 . ISSN   2072-6694. PMC   10670312 . PMID   38001655.
  11. 1 2 Cho-Vega, Jeong Hee; Medeiros, L. Jeffrey; Prieto, Victor G.; Vega, Francisco (2008). "Leukemia Cutis". American Journal of Clinical Pathology. 129 (1): 130–142. doi:10.1309/WYACYWF6NGM3WBRT. ISSN   0002-9173. PMID   18089498.
  12. ↑ Li, Alvin W.; Yin, Emily S.; Stahl, Maximilian; Kim, Tae Kon; Panse, Gauri; Zeidan, Amer M.; Leventhal, Jonathan S. (2017). "The skin as a window to the blood: Cutaneous manifestations of myeloid malignancies". Blood Reviews. 31 (6). Elsevier BV: 370–388. doi:10.1016/j.blre.2017.07.003. ISSN   0268-960X. PMID   28732587.
  13. ↑ Bakst, Richard; Powers, Ann; Yahalom, Joachim (2020). "Diagnostic and Therapeutic Considerations for Extramedullary Leukemia". Current Oncology Reports. 22 (7): 75. doi:10.1007/s11912-020-00919-6. ISSN   1523-3790. PMID   32577912. S2CID   219988937.
  14. ↑ Elsayad, Khaled; Oertel, Michael; Haverkamp, Uwe; Eich, Hans Theodor (2017-01-16). "The effectiveness of radiotherapy for leukemia cutis". Journal of Cancer Research and Clinical Oncology. 143 (5). Springer Science and Business Media LLC: 851–859. doi:10.1007/s00432-016-2338-6. ISSN   0171-5216. PMID   28093639. S2CID   24622600.
  15. ↑ Hsieh, Chen-Hsi; Tien, Hui-Ju; Yu, Yuan-Bin; Wu, Yuan-Hung; Shueng, Pei-Wei; Lu, Yueh-Feng; Wang, Shan-Ying; Wang, Li-Ying (2019). "Simultaneous integrated boost with helical arc radiotherapy of total skin (HEARTS) to treat cutaneous manifestations of advanced, therapy-refractory cutaneous lymphoma and leukemia — dosimetry comparison of different regimens and clinical application". Radiation Oncology. 14 (1): 17. doi: 10.1186/s13014-019-1220-5 . ISSN   1748-717X. PMC   6348688 . PMID   30691490.

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