SAGES 2026 Annual Meeting Emerging Technology Session

Background

Rare presentation of leukemia in which neoplastic leukocytes directly infiltrate the subcutaneous tissue, dermis, or epidermis
Affects 2-30% of all leukemia patients,
Most commonly adult T cell leukemia/lymphoma (ATLL)
Chronic lymphocytic leukemia (CLL) or acute myeloid leukemia (AML) seen more frequently
Risks: Genetic (chromosome 8, 3, t(6;9)), Environmental Exposures (benzene, ionizing radiation, all trans retinoic acid); More common in children (25-30% of all cases)
Pathogenesis not well understood
Chemokine receptors interacting with cell adhesion molecules at post capillary venules
Sites of previous cellulitis or inflammation potentially increases risk

Presentation & Hospital Course

18-year-old male presented to the emergency department with concerns of a rapidly enlarging "lump" at his umbilicus
CT imaging with soft tissue mass and surrounding edema, hepatosplenomegaly, and abdominal lymphadenopathy
Laboratory workup notable for leukocytosis with blast predominance, anemia, thrombocytopenia, and coagulopathy
Urgent surgical excision was performed given concern for necrotizing soft tissue infection
Wound culture and blood culture positive for pseudomonas
Surgical pathology showed atypical infiltration of myelomonocytic cells with focal MPO and CD68 positivity
Subsequently underwent urgent bone marrow biopsy which showed predominance of myeloid blast cells consistent with AML

Discussion

Development of lesions tends to be more rapid in acute leukemia and gradual with chronic leukemia
No association between location of LC and subtype of leukemia
Diagnosis requires biopsy and immunohistochemical analysis of cell surface molecules
Treatment is based on specific type of leukemia, typically responsive to chemotherapy – cutaneous lesions typically regress with responsiveness to chemotherapy
Heliacal Arc Radiotherapy of Total Skin (HEARTS) - whole body radiotherapy for refractory lesions

LEUKEMIA CUTIS A CASE REPORT: RARE PRESENTATION OF ACUTE MYELOID LEUKEMIA IN AN 18-YEAR-OLD MALE.