Chronic lymphocytic leukemia (CLL), the most common type of leukemia, primarily affects blood and organs like the lymph nodes, spleen, and liver. But it can also affect your body’s largest organ — your skin. People living with CLL may describe cutaneous (skin) conditions as lesions, rashes, and eruptions.

Overall, skin lesions can be seen in around 25 percent of people living with CLL. Skin conditions in CLL come in two types — specific and nonspecific — based on how the condition looks and occurs. Leukemia-specific skin lesions are caused by leukemia itself invading the skin. Skin conditions that fall under this category include leukemia cutis and Richter syndrome.

Skin problems not specific to leukemia don’t involve leukemic cells. These skin changes vary from person to person. Nonspecific skin issues occur in 30 percent to 50 percent of people living with CLL. Most of these skin symptoms are caused by some type of infection, but nonspecific skin problems can also include tumors.

This article covers skin issues that can come with CLL and what causes them.

1. Leukemia Cutis and Richter Syndrome

When white blood cells in CLL don’t work properly, they can travel into the skin and cause problems. This infiltration is called leukemia cutis. Researchers don’t exactly know how this process happens, but they think that it has to do with how blood cancer cells and skin cells interact with one another.

Leukemia cutis is a rare skin condition, affecting just 8 percent of people living with CLL. It’s important to recognize leukemia cutis because it can be a sign of Richter syndrome. Also known as “Richter transformation,” this syndrome occurs when CLL becomes an aggressive form of lymphoma. It usually shows up as a sudden and dramatic growth of lymph nodes.

“My oncologist is suspecting Richter Transformation since one of the internal lymph nodes that measured 2 centimeters earlier this year is now at 11 centimeters,” shared one MyLeukemiaTeam member.

Common skin findings in leukemia cutis include papules, nodules, and plaques. A skin biopsy — taking a small amount of tissue to be examined under a microscope — is needed to confirm that you have this condition. Consult your dermatologist if you notice any new changes in your skin.

2. Skin Infections

Most skin lesions in CLL aren’t related to leukemia itself. Instead, they come from infections. Because of their compromised immune systems, people living with CLL can be more susceptible to bacterial, viral, and fungal infections, depending on the medications they take. Common infections include herpes simplex virus, cold sores, and ringworm.

Nonspecific skin lesions are typically caused by toxic and allergic factors. Reduced immunity may play a role, but these skin changes can also occur because of the drugs used to treat CLL. One MyLeukemiaTeam member shared, “I have terrible itching and hives. These are all side effects from the CLL medication.”

It’s important to watch out for any new rashes or swelling along with flu-like symptoms. Contact your health care team if you start to feel ill while starting CLL treatment.

3. Second Skin Tumors

Skin cancer is another example of a nonspecific skin condition in CLL. Skin tumors occur frequently among people living with CLL. “Skin cancer is something most of us have to deal with,” noted one MyLeukemiaTeam member.

These tumors are called “second” skin tumors because they develop after CLL does. Having CLL can make a person eight times more likely to get skin cancer, compared with the general population. This might have to do with exposure to ultraviolet (UV) rays and weakened immunity in people with CLL.

Skin cancer associated with CLL includes squamous cell carcinoma, basal cell carcinoma, melanoma, and some less common types.

Squamous Cell Carcinoma

Squamous cell carcinoma typically shows up on skin that’s been exposed to the sun, including the scalp, hands, ears, face, and limbs. “A few months ago, I had surgery done on my leg for squamous cell carcinoma,” shared one MyLeukemiaTeam member.

However, this type of skin cancer can occur anywhere on the body. In people with darker skin, for instance, squamous cell carcinoma tends to affect areas that don’t get sun exposure.

Squamous cell carcinoma can appear as patchy, open sores that look like warts and may occasionally bleed or crust. As the name says, these skin cancers grow on the skin’s squamous cell layer — the top part of the skin.

Basal Cell Carcinoma

Basal cell carcinoma looks similar to squamous cell carcinoma, but it develops in basal cells. These cells are also located in the skin’s top layer but they’re below the squamous cells, in the area where new skin cells are made.

Basal cell carcinoma can develop in sun-exposed areas like the face, hands, and limbs. This type of skin cancer may appear as flesh-colored bumps on light skin and as glossy brown or black bumps on dark skin. Very commonly, basal cell carcinoma develops on the lip, appearing like a sore that doesn’t heal.

Melanoma

Melanoma, the most dangerous form of skin cancer, develops on skin cells called melanocytes. Melanocytes can become cancerous from overexposure to UV rays. People living with CLL are at an increased risk of melanoma because of having a weakened immune system, which may be the result of their CLL treatment.

Melanomas can vary in appearance, but they typically come from moles that are either new or growing. Early detection is key in curing melanoma. “I was officially diagnosed with CLL in 2008 by my melanoma doctor when he found it doing the blood work for my first melanoma skin cancer,” shared a MyLeukemiaTeam member. “I have had three melanomas, all on my left arm.”

Other Skin Cancers Linked With Chronic Lymphocytic Leukemia

Some less common skin cancers also are associated with CLL. These include:

• Merkel cell carcinoma
• Kaposi’s sarcoma
• Sebaceous carcinoma

It’s common to mistake the symptoms of these skin cancers for noncancerous skin issues. Be sure to discuss skin changes with your dermatologist or hematologist at follow-up appointments.

4. Other Skin Symptoms

People living with CLL may develop other skin symptoms because of their disease and its treatment. These symptoms include various types of bruising and rashes that look like bugbites.

Bruising

Typically, bruises are caused by some sort of injury. But if bruises randomly show up, they may be a sign of a medical issue.

CLL produces abnormal lymphocytes (a type of white blood cells) that take up too much space in the bone marrow. This makes it harder to make platelets, cell fragments in blood that help form clots. With fewer platelets, people with CLL may experience more bleeding. This explains why people with CLL frequently bruise.

Your provider may call your bruises by different names depending on their size. Types of bruising common in CLL include:

• Petechiae — Flat, discolored, dotlike bruises, which are usually harmless but can be a sign of a blood problem
• Purpura — A red, purple, brown, or black rash, depending on skin tone, with spots that are slightly bigger than petechiae
• Ecchymoses — Bruises that are larger than purpura and petechiae

All of these lesions indicate a low platelet count, which can occur in advanced stages of CLL.

Insect Bite-Like Reactions

A majority of people living with CLL may experience what are called “insect bite-like reactions.” These aren’t actual bugbites — they’re abnormal itchy rashes caused by CLL. These differ from bugbites in that they’re sometimes found in areas you wouldn’t expect to get bitten.

Check With Your Doctor About Skin Issues

Your doctor can help you understand the cause of skin issues with CLL and find the best treatment options to manage them. Be sure to take note of any new or worsening symptoms of CLL or side effects of medications. You can report these to your hematology or dermatology physician at your next appointment. Many symptoms and side effects will improve with medications and lifestyle changes recommended by your health care provider.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 18,000 members who understand life with leukemia come together to share support, advice, and stories from their daily lives.

Have you experienced CLL-related skin problems? How have you managed them alongside your CLL? Share your thoughts in the comments below or by posting on your Activities page.