Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran

Leukemia cutis is one of the cutaneous symptoms of the disease. In this case study, a patient with myeloid leukaemia m5 presented an unusual cutaneous manifestation of leukaemia cutis that was characterised by hyperpigmented reddish to brown patches on the face and upper body. According to our knowledge, the literature hardly ever describes hyperpigmented patches that result from leukaemia cutis.

KEYWORDS: Leukemia, hyperpigmentation, and leukaemia cutis

Leukemia is a neoplasm that affects the haematological system and has the potential to be deadly and life-threatening. 1 Leukemia cutis refers to the direct invasion of leukemic neoplastic cells in the skin layers. 1 Acute myelomonocytic leukaemia (AML-4) and AML-M5, which have the highest prevalence of cutaneous manifestations, are the subtypes of leukaemia that are most frequently associated with leukaemia cutis. 2 Leukemia cutis is present in 2.9% to 3.7% of AML patients, on average. 2 We describe a 76-year-old man who initially had a skin rash but later developed acute myeloid leukaemia (AML). On examination, the patient had hyperpigmented patches on the face, upper trunk, and ocular and oral mucosal alterations. AML-M5 was discovered by additional testing, and a skin biopsy revealed invasion.

A 76-year-old man with six months' worth of skin hyperpigmentation and weariness visited our clinic. He had no major past medical history. Skin-lightening and antisolar lotions were used on the patient, but no improvement was seen. On the face and upper trunk, clinical examination revealed brown to violet hyperpigmented areas. A mucosal examination revealed yellow sclera with red to purple areas on the inner surface of both lower eyelids and violaceous plaques on the upper palate (Figure 1). A physical examination revealed lymphadenopathy, particularly in the axilla. White blood cell counts of 4.6 103/L with neutrophil and lymphocyte differentiation of 18% and 50%, respectively, were revealed by laboratory tests, along with haemoglobin levels of 10.5 g/dl and a platelet count of 72 103/L. Two skin biopsies from the chest and face were performed, and the differential diagnosis were in addition to lichen planus. IHC evidence consistent with leukemic dermal infiltration was present, as was dense dermal multinodular perivascular and periad-nexal infiltration with atypical mononucleated cells (Figure 2). According to morphological observations, immunohistochemistry (IHC) labelling was performed and revealed infiltrating cells with irregularly indented nuclei and a high nuclear/cytoplasmic ratio, which were positive for leukocyte common antigen (LCA). There were no signs of CD20, CD79a, CD3, CD45, CD30, MPO, or CD68 infiltrating cells. Peripheral blood flow cytometry immunophenotyping, along with clinical and histological results, were consistent with myeloid leukaemia m5.

A variety of non-specific reactive skin lesions or particular infiltrates can be seen in patients with underlying hematologic malignancies. 3 Leukemia cutis, which manifests clinically as erythematous papules, nodules, plaques, bullae, noduloulcerative lesions, and even erythroderma, is a cutaneous infiltration of neoplastic leukocytes. 3 The lesions are frequently hemorrhagic or hard lesions. The face, head, neck, and trunk are the most often affected areas.Notwithstanding regular run of the mill skin appearances, the recorded uncommon signs of leukemia cutis were summed up in review concentrate in 2021 by Yung-WeiChang, which included leonine countenances, figurate cuta-neous sores, fingertip hypertrophy, erythema nodosum, guttate psoriasis, persistent paronychia, leukemic vasculitis, and Sister Mary Joseph's nodule.4Our patient was grumbling of hyperpigmented patches on the face and upper trunk from a half year prior to introducing to our facility, and sadly, the patches were treated as skin pigmentation.Involvement of skin should be visible in any leukemia sub-type, yet most generally found in intense myeloid leukemia (AML) with monocytic or myelomonocytic and constant lymphocytic leukemia (CLL), and seldom in persistent my-eloid leukemia (CML), which can be characteristic for impact transformation.5The conclusion of leukemia cutis is typically accomplished by histological review and immunophenotyping.6 Histological discoveries change as per the kind of leukemia and generally present as perivascular and periadnexal der-mal infiltrate.6,7 Extra infrequent finding incorporates stromal fibrosis, ulceration, dermal vessel blood clot, and subcutaneous.7Currently, there is no particular therapy for leukemia cutis, and cutaneous ejection as a rule settle keeping therapy of hidden leukemia According to our knowledge, leukaemia cutis-related hyperpigmented patches are infrequently discussed in the literature. Dermatologists may be crucial in the detection of internal illnesses like leukaemia. Delaying the diagnosis of the underlying leukaemia also delays the diagnosis of leukaemia cutis, which has a terrible prognosis. An early diagnosis of leukaemia cutis can improve outcomes and point to an underlying cancer.

The clinical portion of the text was written by NN, who also assisted with patient diagnosis and treatment. ZAK released the histopathological evaluation's findings. A literature review was done and the paper was written by NN, RD, and AK. NN oversaw the study's planning and was in charge of the manuscript's last editing. The final manuscript has been read by and approved by all writers.

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Reem Diab . Hyperpigmented patches are a symptom of leukaemia cutis. a unique display. Insights of Clinical and Medical Images 2022.