Skin Lesions and MDS

Myelodysplastic syndrome (MDS) is a blood cancer that often affects older adults. While some people may not experience any initial symptoms, others might develop specific skin lesions called leukemia cutis. This rare condition occurs when leukemia cells invade the skin, causing patches or bumps. These lesions can be a sign of advanced MDS and may appear before, during, or after an official diagnosis.

What is Leukemia Cutis?

A recent study analyzed 134 patients with MDS and various skin manifestations. 

“Because leukemia cutis can vary so much, people may mistake the lesions for other skin conditions, such as psoriasis or eczema. Lesions can appear before or after the diagnosis, but they usually develop afterward.”

Researchers identified six types of MDS-associated skin lesions:

• Neutrophilic dermatoses: The most common type, this condition appears as a painful rash, pus-filled bumps, or blisters (also known as Sweet syndrome).
• Vasculitis: This involves inflammation of blood vessels.
• Granulomatous: This type of skin involvement is linked to a more aggressive form of MDS and a higher risk of progressing to acute myeloid leukemia (AML).
• Connective tissue disease (CTD): Skin changes resembling other autoimmune disorders.
• Panniculitis: Inflammation of the fatty layer under the skin.
• Immunobullous: This type causes blisters on the skin and mucous membranes.

The study found that these lesions could occur at any point – before (34.7%), during (25.3%), or after (40%) diagnosis of MDS.  Unfortunately, the presence of leukemia cutis is associated with a poorer prognosis, with over 34% of patients developing AML.

Importance of Early Detection

Early diagnosis and treatment are crucial for managing MDS effectively.  Leukemia cutis can be a valuable early warning sign, prompting further investigation and potentially more intensive treatment options.  It's also important to note that leukemia cutis is a form of extramedullary disease (EMD), where leukemia cells spread beyond the bone marrow and infiltrate other organs.

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Sources: 

• Cutaneous manifestations of myelodysplastic syndrome: A systematic review
• Leukemia cutis: Symptoms and treatment