Chronic lymphocytic leukemia (CLL) is one of the most common types of adult leukemia. It begins in the bone marrow, leading to an overproduction of a type of white blood cell called lymphocytes.

Unlike other forms of leukemia, CLL tends to develop gradually. While early symptoms may include fatigue and enlarged lymph nodes, it’s also possible to experience various skin issues or cutaneous lesions.

It’s estimated that 25 percent of people with CLL experience skin lesions. Additionally, CLL may also increase your risk of developing secondary skin cancers.

Learn more about CLL skin lesions, including their causes, what they look like, and how they’re usually treated.

Symptoms of CLL-related skin lesions can differ from person to person, but may include the following:

  • widespread redness and inflammation of your skin (exfoliative erythroderma)
  • general itchiness of your skin, with or without lesions or plaques
  • large, painful nodules (nodular erythema)
  • large, itchy, fluid-filled blisters (bullous pemphigoid)
  • large, painful blisters that can appear on your lips, mouth, and skin (paraneoplastic pemphigus)
  • an increased risk of skin infections, such as after being bit by a bug

CLL may also cause you to bleed or bruise easily. As the cancer progresses, this can lead to small pinpoints of dark spots under your skin called petechiae.

CLL is a slow-developing form of leukemia. You may not experience symptoms such as skin lesions until the cancer has progressed.

If you have CLL, blood stem cells that normally become healthy red or white blood cells turn into atypical lymphocytes instead.

Also called leukemia cells, these lymphocytes may crowd your blood and bone marrow, spreading into your skin and decreasing healthy red and white blood cells as well as platelets.

There are three types of lymphocytes:

  • B lymphocytes (B cells), which usually create antibodies that help fight infections
  • T lymphocytes, which help create antibodies for B cells
  • “natural killer cells,” which fight viruses and cancerous cells

Having too many lymphocytes from CLL may also result in skin lesions and increase your risk of related infections. CLL-related skin lesions are also called leukemia cutis.

The types of skin lesions that may be associated with CLL include:

  • bullous pemphigoid
  • exfoliative erythroderma
  • nodular erythema
  • paraneoplastic pemphigus

With CLL, you may be up to 8 times more likely to develop secondary skin cancers compared to someone who does not have this cancer. These secondary skin cancers can include:

Since the risk of developing secondary skin cancers from CLL is high, it’s important to check your skin at least monthly for any signs of suspicious lesions.

Contact a doctor or dermatologist if you notice:

  • a mole that is changing in size and color and that looks different from other moles you may have
  • a scaly patch that does not go away
  • any dome-shaped growths
  • itching, bleeding, or nonhealing sores that do not go away or that return
  • streaks under your nails that are brown or black

A dermatologist may conduct a biopsy of the lesion. This involves taking a small sample of the mole or lesion to look for cancerous cells under a microscope.

The earlier skin cancer is found, the sooner you can start treatment and stop it from spreading.

Treatment for CLL-related skin lesions usually involves targeting the underlying cancer cells. Treatment options for CLL may include:

  • chemotherapy, which kills cancer cells
  • leukapheresis, which involves removing white blood cells via a specialized machine
  • radiation therapy, which destroys cancer cells with high energy rays
  • stem cell transplants, with or without chemotherapy
  • targeted therapies, such as monoclonal antibodies

If you’re experiencing skin infections from leukemia cutis, you may also need to take antibiotics to help prevent the spread of bacteria.

It’s important to see a doctor to address unusual skin lesions. Not only is there an increased risk of infections, but these lesions could also be signs of CLL progression.

CLL may spread to other parts of your body, especially the lymph nodes, spleen, and liver. Aside from skin lesions and secondary skin cancers, other possible signs of CLL progression may include:

  • extreme fatigue and weakness
  • swollen but painless lymph nodes
  • frequent infections
  • night sweats
  • fullness or pain below your ribs
  • unintentional weight loss
  • Richter’s syndrome

A doctor will check your white and red blood cell numbers as well as your platelets to determine the extent of the cancer. Imaging tests, such as X-rays, may also be needed to see whether CLL has spread.

CLL skin lesions occur when leukemia cells enter the skin. This can cause skin issues, such as bruises, blisters, plaques, and tumors. Widespread redness, itchiness, and inflammation are also possible.

While not the most common early symptoms of CLL, skin lesions could indicate that the cancer has spread. It’s also possible to develop secondary skin cancers once you have CLL.

It’s important to see a doctor right away if you develop any new skin lesions, unusual moles, or signs of a skin infection. Treatment for CLL may help improve symptoms of related skin lesions. Secondary skin cancers and infections will require separate treatments.