Dense lymphocytic infiltrates associated with non-melanoma skin cancer in patients with chronic lymphocytic leukemia.

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Dense lymphocytic infiltrates associated with non-melanoma skin cancer in

patients with chronic lymphocytic leukemia.

ML , DM Elston, WB Tyler, VJ Marks, and T Ferringer

Dermatol Online J, January 1, 2010; 16(3): 4.

Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania.

mlwilson@....

Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy associated

with an increased risk of non-melanoma skin cancer. Basal cell carcinomas and

squamous cell carcinomas in these patients may have an associated dense

peritumoral leukemic infiltrate. This infiltrate can lead to the diagnosis of

CLL and may also obscure tumor margins and pose a challenge in the assessment of

perineural tumor spread. Immunohistochemical stains are useful in distinguishing

leukemic B-cell infiltrates from tumor-reactive T-cell infiltrates. Leukemic

cells of CLL are CD20+/CD23+/CD5+/CD43+/CD3-, whereas benign reactive

infiltrates are composed of CD20-/CD23-/CD5+/CD43+/CD3+ T-cells. Given the

paucity of symptoms in early stages of CLL, a dense lymphoid infiltrate

surrounding a cutaneous neoplasm may serve as the first indication of CLL. We

report a series of three cases of SCC with a coexisting infiltrate of CLL,

including one with perineural involvement, one involving metastatic SCC, and one

in which this histologic finding spurred the initial diagnosis of CLL.

PMID: 20233561

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