The skin manifestations associated with leukaemia and allied conditions / Sir Humphry Rolleston, Bt., K.C.B., M.D., D. Sc., P.R.C.P.

  • Rolleston, Humphry Davy, Sir, 1862-1944.
Date:
[1924?]
Catalogue details

Licence: In copyright

Credit: The skin manifestations associated with leukaemia and allied conditions / Sir Humphry Rolleston, Bt., K.C.B., M.D., D. Sc., P.R.C.P. Source: Wellcome Collection.

    5/22 (page 5)
    mechanical factor may in certain circumstances be of importance, though it does not occur in neurofibromatosis or in multiple malignant metastases in the skin. (li) That chronic myeloid leukaemia is very rarely accompanied by cutaneous manifestations of any kind, thus contrasting with the rarer disease chronic lymphoid leukaemia, in which a considerable number of cases with cutaneous changes are on record. This difference is compatible with the belief that the two diseases are much further apart in their nature and aetiology than is generally believed. It might perhaps be imagined that toxins derived from lymphoid elements are more prone to irritate the skin than are the disintegrated proteins derived from destruc¬ tion of the marrow-cells. This suggestion might be thought to be nega¬ tived by the absence of rashes in infectious mononucleosis (Sprunt and Evans), which is probably the same as glandular fever, and by the occur¬ rence of cutaneous manifestations in a certain number of cases of acute leukaemia, which is often an acute myeloid leukaemia ; but it must be remembered that acute leukaemia is prone to blood infections, which may thus account for a certain number of cutaneous manifestations. The question has naturally been debated whether leukaemia cutis is a passive infiltration of the skin or an active proliferation—in fact a new growth as in chloroma. In chronic lymphoid leukaemia mitoses have been described in the skin lesions by Arndt and by Butler, but more recently Ketron and Gray (16) were unable to confirm this. Leukaemia cutis or genuine leukaemic tumours of the skin, first described by Biesiadecki in 1876, may for convenience be considered as a whole, so as to avoid repetition under the headings of “ acute” and “ chronic.” Cutaneous leukaemic tumours are very persistent, and seldom, as in Ketron and Gay’s case (17), come and go. They usually grow slowly and do not ulcerate spontaneously, though, in rare instances, ulceration is due to trauma and sepsis. They may appear at any time in the course of the diseased ; in some instances the cutaneous tumours precede the blood changes (Butler; Ketron and Gay (17)), thus clinically resembling the supposed transformation of lymphadenoma into leukaemia. Usually symmetrical, they most often occur on the face, scalp, cheeks and eyelids. The leonine aspect of the face may then resemble that of tubercular leprosy. The tumours are nodular, or flat, discrete, or may become confluent. They are usually slaty blue or plum-coloured, and may suggest a diagnosis of melanotic metastases.