Mucocutaneous Manifestations of Leukemias and Lymphomas: A Clinical Study from a Tertiary Care Center in North India.

Abstract

Background: Mucocutaneous manifestations are common in hematological malignancies, but are generally misinterpreted. About two-thirds of the patients with hematological malignancies have mucocutaneous manifestations. Specific manifestations include leukemia cutis, leukemic vasculitis, and mucosal hyperplasia. Non-specific manifestations include reactive dermatoses, infective dermatoses, and miscellaneous manifestations. Mucocutaneous manifestations help in depicting the course and prognosis of hematological malignancies.

Aim and objectives: To determine the frequency and pattern of mucocutaneous manifestations in patients with leukemia and lymphoma, and to determine the degree of correlation between various mucocutaneous manifestations and the types of leukemias and lymphomas.

Patients and methods: This cross-sectional study was conducted in hematology and dermatology outpatient and inpatient departments in a tertiary care center in North India for 18 months. The study included 177 newly diagnosed leukemia and lymphoma patients who had not undergone chemotherapy.

Results: Mucocutaneous manifestations were noted in 87.57% of patients, with specific manifestations in 5.08% (gingival hyperplasia = 3.39%, leukemic vasculitis = 1.13%, leukemia cutis = 0.56%) and non-specific manifestations in 87.01% (reactive dermatoses = 4.52%, infective dermatoses = 30.5%, miscellaneous = 76.27%). Acute myeloid leukemia (AML) showed the highest frequency (96.88%) of mucocutaneous involvement. AML was significantly associated with pallor ( P value <0.001), thrombocytopenic purpura ( P value <0.001), xerosis ( P value = 0.023), and bacterial infections ( P value = 0.028).

Limitations: A small sample size and a cross-sectional design, that precluded the correlation between course of muco- cutaneous manifestations and disease progression.

Conclusion: Mucocutaneous manifestations are common in acute leukemias, particularly myeloid lineage, due to bone-marrow suppression, immune dysregulation, and cutaneous spread. B-cell neoplasms show a higher propensity for skin involvement and paraneoplastic phenomena due to their aggressive nature compared to T-cell neoplasms.