Clinical Features

Specific skin lesions of AMoL and AMMoL present as violaceous to red-brown papules, nodules, and plaques (Figs. 1 and 2) (4,5,8). They are most commonly located on the trunk and extremities, but they can occur anywhere in either a grouped or a generalized pattern. Occasionally, a solitary red, sometimes, necrotic or ulcerated, nodule is found. The eruption may also involve the face and scalp. Mucocutaneous leukemic infiltrates were found in 24 of 81 patients with AMMoL (6). Leukemic gingival hyperplasia is a striking feature of AMoL and AMMoL. The infiltrated gingiva appear swollen, glazed, firm in consistency, and bright red to deep purple in color (6,8). The gums may completely cover the teeth. Deep oral ulcerations may occur in areas subjected to trauma such as the hard palate and tongue (Fig. 3). Specific skin lesions tend to localize at sites of trauma, burns, herpes zoster scars, and catheter placement (3,4,9). Unusual manifestations of AMoL and AMMoL include hemorrhagic bulla (10), conjunctival lesions (11), and a vesicular skin rash mimicking chickenpox (12). The leukemic cells of AMMoL can be found within psoriatic skin plaques (13). Aleukemic leukemia cutis is a rare condition in

Figure 1 Acute monocytic leukemia (AMoL, M5) presenting as disseminated pale-red papules.

which leukemic cells invade the skin in the absence of peripheral blood and bone marrow involvement. Such lesions may be present several months before diagnosis, but the prognosis is poor after the full leukemic disease develops. Aleukemic skin lesions present as solitary or multiple red or violaceous papules or cutaneous and subcutaneous nodules (14-19). Specific skin lesions are considered to be a poor prognostic sign, and most patients die within a few months (8,20-22).

Figure 2 Acute myelomonocytic leukemia (AMMoL, M4). Multiple indurated pink-red papules on the trunk.

Figure 3 Acute myelomonocytic leukemia (AMMoL, M4). Leukemic infiltrate presenting as a painful and deep ulceration on the tongue.

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