Subclinical chronic lymphocytic leukaemia associated with a 13q deletion presenting initially in the skin: apropos of a case

  B‐cell chronic lymphocytic leukaemia (B‐CLL) represents a low‐grade B‐cell lymphoproliferative disease that is the most common leukaemia in adults. The neoplastic cell is an autoreactive CD5 CD23 B lymphocyte. B‐CLL may involve the skin, typically in the context of known disease. We present a case of subclinical B‐CLL presenting initially in the skin. Case Report:  A 73‐year‐old male developed a lesion on his right cheek in April 2003 compatible with basal cell carcinoma. The re‐excision specimen contained a well‐differentiated atypical lymphocytic infiltrate consistent with B‐CLL along with residual carcinoma. Subsequent laboratory studies revealed peripheral blood lymphocytosis with smudge cells. A diagnosis was made of Rai stage 0 CLL. Chromosomal studies on peripheral blood showed a deletion at 13q14.3. Excision of a second primary skin carcinoma revealed a squamous cell carcinoma in association with B‐CLL that was identical to his previously diagnosed skin involvement. Conclusion:  This case identifies a cutaneous presentation of subclinical B‐CLL. There are two prior reports describing B‐CLL presenting initially in the skin. In one case, the infiltrates were incidental on a re‐excision specimen. The second report suggests 16% of B‐CLL patients have cutaneous manifestations as the first sign of disease.