In the post-transplant setting, the differential diagnosis of cutaneous lesions, particularly those with a dense dermal infiltrate, includes graft-versus-host disease (GVHD), infection, drug reaction, and leukemia cutis. Myeloid leukemia may pose a particular problem in that there is loss of key myeloid markers which help distinguish the blasts. Further complicating the picture are T-cell malignancies with epidermotropism and immunohistologic markers which may overlap with those found in GVHD. In this chapter, we present a case of leukemia cutis and discuss the potential pitfalls, such as cases of cellular rich phase of GVHD with increased numbers of dermal monocytes.
Leukemia cutis GVHD Skin AML Chloroma GVHD with monocytes Mycosis fungoides Sézary syndrome
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