Discussion
Leukemia cutis is rare, affecting approximately 3% of leukemia patients1. It can present as papules, nodules, plaques, erythema, purpura, or eczematiform rash. Typically, lesions are multiple; solitary lesions are very rare, and ulceration and severe erythema are uncommon2. Notably, no previous reports describe a hemangioma-like appearance as observed in our case. Generally, leukemia cutis appears in individuals already diagnosed with leukemia, and it is exceedingly rare for it to be the initial sign of hematologic malignancy (aleukemic leukemia cutis)3. Although our patient presented with a hemangioma-like lesion at 7 weeks of age, aleukemic leukemia cutis could not be ruled out as no laboratory tests were performed at that time. The initial presentation as an infantile hemangioma, combined with the lesion’s atypical firmness on exam and the presence of systemic symptoms, suggested a more serious etiology. Biopsy remains the gold standard for accurate diagnosis in atypical cases4.