Leukemia cutis in acute lymphoblastic leukemia

separating normal epidermis from a diffuse dermal infiltrate of lymphoid blast cells with round and regular nuclei, inconspicuous nucleoli, and scanty, moderately basophilic cytoplasm. Immunophenotype analysis revealed strong positivity for CD 10.The patient wastreated with methotrexate, teniposide, cytosine arabinoside, and local irradiation, and a second complete remission was induced. In December 1990, while the patient continued to receive maintenance chemotherapy, a nodule appeared in his right leg, adjacent to the previously irradiated field. Again, no other organs or systems were involved. In March 1991 the patient had autologous bone marrow transplantation. The conditioning regimen consisted of busulfan, 16 rug/kg, and melphalan, 180 mg/m2, and a third complete remission was achieved. In January 1992 the patient noticed reappearance of two nodules in the right leg. During the next 2 months more than 100 papules and nodules developed on his chest, back, shoulders, arms, neck, and face (Fig. I). Laboratory findings were unremarkable, and both the bone marrow and cerebrospinal fluid were negative for leukemic cells. The histopathologic findings in the skin Fig. 1. Patient's back shows numerous papules and nodules.