Specific skin lesions occur in approximately 8% of patients with B-CLL. The reported incidence of cutaneous lesions ranges from 4% to 45% (3), if one takes account of nonspecific findings including purpura, ecchymoses, and maculopapular eruptions. Specific lesions usually present as red or violaceous macules, papules, or nodules (4-7). Single or multiple lesions may be present. Lesions are typically seen on the face, particularly the ears, but may also frequently be seen on the scalp, trunk, and the extremities. Generalized lesions were seen in 17 of 42 patients with specific cutaneous infiltrates of B-CLL (8). The lesions may appear at the sites of herpes simplex and herpes zoster scars; they may be temporary regressing without treatment (9-11) (Fig. 1). Infection with Borrelia burgdorferi can trigger the development of specific cutaneous infiltrates which may occur at the sites typical for borrelial lym-phocytoma such as the nipple, scrotum, and earlobe (12). In addition, a predilection for specific infiltrates to arise at the site of squamous cell carcinoma, basal cell
carcinoma, and actinic keratosis has been observed (13). Atypical manifestations of cutaneous B-CLL have included chronic paronychia (14), subungual erythematous nodules involving several fingers (15), dystrophy of toenails resembling onychomycosis (16), finger clubbing with periosteal bone destruction of the distal digits (17), and papulovesicular eruption of the face (18). The prognosis varies, depending upon clinical stage; the presence of specific skin lesions in patients with B-CLL does not seem to be an independent poor prognostic sign (8).
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