Biclonal chronic lymphocytic leukemia presenting as skin lesion.

Chronic lymphocytic leukemia (CLL) is by far the most common mature B-cell leukemia in Western countries. Some patients with CLL present with manifestations of extra medullary disease. We report a case of biclonal CLL/small lymphocytic lymphoma in an elderly patient who initially presented with skin lesions, no other systemic symptoms, and normal white cell count. Skin biopsy revealed concurrence of basal cell carcinoma and a nodular dermal infiltrate with immunophenotype consistent with CLL/small lymphocytic lymphoma. Polymerase chain reaction assay for immunoglobulin heavy chain gene rearrangement revealed the presence of 2 distinct B-cell clones in the peripheral blood. The clinicopathological characterization of this case is presented here.