In our patients, at first, we considered a diagnosis of cutaneous mastocytosis, lymphoma or leukemia. To differentiate, we performed a biopsy on left abdomen. From the results of immunohistochemical stains, we could exclude lymphoma from the fact that it showed negative findings on CD3, UCHL, CD20, CD79a, which are the markers for lymphocytes. And we could also rule out mastocytosis from the negative findings on giemsa and toluidine blue stains. It showed negative on myeloperoxidase, the markers for granulocytes and positive on CD 68 stain, the markers for monocytes. After considering all those results, she was diagnosed as acute monocytic leukemia M5B.

Accurate identification is important in scheduling adequate management of patients with leukemia, particularly in cases where skin lesions are the first clinical sign of the disease. Most reports demonstrated that local irradiation alone is ineffective in preventing subsequent development of overt leukemia and the outcome is dismal. Conventional chemotherapy regimens are advocated in leukemia cutis. In our case, she underwent a successful cord blood stem cell transplantation after systemic chemotherapy.
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Whereas leukemia cutis is associated with a poor prognosis in adult leukemics, the natural history of congenital leukemia is not altered by leukemia cutis. The natural history of congenital leukemia is nearly universally lethal if not treated, with almost all infants dying by 2 months. The survival rate of congenital AML is reported to be as low as 26%, compared with older children who have an improved survival rate of 40% to 60%. Its early recognition is important, because early diagnosis can lead to appropriate treatment, followed by a better prognosis. We, herein, report a case of congenital leukemia cutis treated successfully with cord blood stem cell transplantation.