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

Dermatol Online J. 2010 Mar 15;16(3):4.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antigens, CD20 / analysis
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology
  • Biomarkers, Tumor / analysis
  • CD3 Complex / analysis
  • CD5 Antigens / analysis
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / immunology
  • Carcinoma, Squamous Cell / pathology
  • Humans
  • Immunohistochemistry
  • Leukemia, Lymphocytic, Chronic, B-Cell / diagnosis*
  • Leukemia, Lymphocytic, Chronic, B-Cell / immunology
  • Leukemia, Lymphocytic, Chronic, B-Cell / pathology
  • Leukemic Infiltration / diagnosis*
  • Leukemic Infiltration / immunology
  • Leukemic Infiltration / pathology
  • Leukosialin / analysis
  • Male
  • Receptors, IgE / analysis
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / immunology
  • Skin Neoplasms / pathology
  • T-Lymphocytes / immunology
  • T-Lymphocytes / pathology

Substances

  • Antigens, CD20
  • Biomarkers, Tumor
  • CD3 Complex
  • CD5 Antigens
  • Leukosialin
  • Receptors, IgE