Background: Specific cutaneous infiltrates in patients with leukemia generally carry a grim prognosis. However, nonneoplastic skin diseases may be associated with recruitment of normal and neoplastic leukocytes circulating in the peripher al blood. In those instances, neoplastic cells may be detected in skin lesions w ithout an adverse effect on prognosis. Methods: In a patient with B-cell chroni c lymphocytic leukemia,a specific infiltrate developed at the site of a florid h erpes simplex infection. Clinically, the lesion presented itself as an ulcerated tumor. Results: Histopathologically, the lesion was characterized by a dense, d iffuse infiltrate of small hyperchromatic lymphocytes throughout the entire derm is. Lymphocytes showed an aberrant CD20 +/CD43+/CD5+phenotype of neoplastic B cells, and monoclonal rearrangement of immunoglobulin gamma genes could be demo nstrated by polymerase chain reaction. Although criteria for leukemia cutis were fulfilled, the patient did well. Conclusions: The cutaneous infiltrate of neopl astic cells seemed to be part of a physiologic response to the antigenic stimulu s, rather than indicating an exacerbation of leukemia.
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