Second Malignancies in Chronic Lymphocytic Leukemia

A 73-year-old patient named Mr. G was diagnosed with Rai stage 0 chronic lymphocytic leukemia (CLL) in 2007. The diagnosis was made incidentally by a routine complete blood count that reported lymphocytosis, and the diagnosis was confirmed by flow cytometry. His family history for cancer only included a sister previously diagnosed with melanoma. Because of his early stage, he was followed in clinic and remained asymptomatic for three years. He then presented with supraclavicular and bilateral axillary lymphadenopathy measuring 4-6 cm, a rising white blood cell count of 43,620 u/L, and hemoglobin and platelet count slightly less than normal (12 g/dl and 136,000 u/L, respectively). Mr. G was started on chlorambucil and, after two months of treatment, was held because of a generalized papular erythematous rash covering 40% of his back, chest, and arms. He was referred to dermatology for assessment, and biopsy confirmed the rash as leukemic infiltration of the skin. A second biopsy performed on a 2 cm lesion found incidentally behind his right ear was positive for basal cell carcinoma (BCC).