A 71-year-old Iraqi woman presented with a fever, pallor, easy fatigability and skin lesions all over the body. At presentation, the physical examination revealed anemia, splenomegaly and hepatomegaly.

An ultrasound of abdomen showed hepatomegaly (19 cm) and splenomegaly (22 cm).

Her peripheral blood counts were as follows: white blood cell [WBC] 24x10⁹/L, hemoglobin 10 g/dl, platelet 26×10⁹/L with 30% circulating blasts.

Bone marrow smears were hypercellular with heavy infiltration by undifferentiated blast cells, heterogeneous in size, moderate to high N/C ratio, visible single nucleoli.

Bone marrow aspirate flow cytometry revealed distinct cell cluster in the blastic region comprising 46% of all gated events with the following phenotype: CD33+, CD117+, CD7+ & HLADR. The blasts were negative for cMPO, CD19, CD20, CD13, CD14, CD64, confirming the diagnosis of acute myeloid leukemia.

A skin biopsy showed dermal infiltrate of round neoplastic cells infiltrating deep into the dermis with frequent mitosis. Immunohistochemical staining showed positive reaction for CD45 and CD34, so the diagnosis of leukemia cutis was established.

Leukemia cutis (LC) is a rare neoplastic infiltration of the skin or subcutaneous tissue by leukemic cells. Because it correlates with sites of additional extramedullary involvement, it typically portends a poor prognosis. Although most cases of LC present concurrently with bone marrow infiltration, skin findings may precede systemic involvement in some cases; thus, early detection by dermatologists is essential.