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AbstractObjectiveThis work was carried out to identify the prevelance of skin lesions in pediatric patients with hematologic malignancies . To achieve this aim , this work was carried out on 100 children with hematologic malignancies (75 patients with leukemia and 25 patients with lymphoma ) . Patients were diagnosed , treated and followed up in the oncology unit of pediatric department, Zagazig University in the period from December 2004 to April 2006 .Patients and methodsAll patients were subject to the following:● Full history taking● Complete general examination .● Detailed dermatological examination .● Dermatologic investigations● Photographic taking● Registeration of cutaneous signsConclusionThe prevelance of skin lesions in our patients was highly significant as 81 % of the patients developed skin lesions at some time during the course of their disease . From previous results we conclude that there is high incidence of skin lesions in pediatric patients with hematologic malignancies .The lesions are mainly non-specific and may develop due to chemotherapy , infection by different pathogens , or as paraneoplastic lesions .Summary and conclusionAcute lymphoplastic leukemia is the most common malignancy of Childhood ,representing nearly one third of all pediatric cancers and the second leading cause of death in children under 15 years of age (Rubnitz et al.,2002) .Lymphomas including Non Hodgkin’s lymphoma and Hodgkin’s disease ( NHL and HD) constitute approximately 10% of all childhood cancers ( Shad and Magrath ,1998 ) .Cutaneous lesions can be observed in pediatric patients with hematologic malignancies . These cutaneous lesions that accompany systemic leukemia or lymphoma have been usually divided into two categories , the specific malignant lesions and the non specific benign lesions ( Fre’de’ric et al., 1997 ) .This work was carried out to identify the prevelance of skin lesions in pediatric patients with hematologic malignancies . To achieve this aim , this work was carried out on 100 children with hematologic malignancies (75 patients with leukemia and 25 patients with lymphoma ) . Patients were diagnosed , treated and followed up in the oncology unit of pediatric department, Zagazig University in the period from December 2004 to April 2006 .All patients were subject to the following:● Full history taking including the type of malignancy , duration of illnessand the type of therapy taken in details .● Complete general examination .● Detailed dermatological examination .● Dermatologic investigations : for confirmation of the clinical diagnosis as skin scrapping and direct light microscopy examination for fungal hyphae and spores and Cultures, either bacterial or fungal , only when indicated .● Photographic taking of all skin lesions detected in the study .● Registeration of cutaneous signs deteced in patients with hematologicmalignancy .Obtained data were statistically analyzed and results revealed the following :1- The prevelance of skin lesions in our patients was highly significant (P<0.01), as 81 % of the patients developed skin lesions at some time during the course of their disease .2- All lesions detected were non-specific lesions while non of patients develop specific skin lesions .3- The prevelance of skin lesions in children with leukemia (82.7%) was higher than that detected in children with lymphoma (76%) .4- There was no statistical significant difference between studied groups as regard age and sex (p> 0.05).5- Infective cutaneous lesions were found in 22% of our patients . Fungal infections were the most frequent infection among cases ( 45.4% ), followed by bacterial infections (36.4%).6- Skin lesions due to adverse reaction to chemotherapy developed in 61% of patients . Alopecia ; the most distressing side effect of cancer chemotherapy ; occurred in 37% of our patients, while localized and generalized hyperpigmentations were the second most common cutaneous lesions due to chemotherapy where it occurred in 27% of cases .7- Non-infectious skin lesions developed in half of our patients (50%) at some time during their disease and they were more frequent in cases with leukemia than those with lymphoma .8- The most significant non-infectious lesions were pallor (50%), purpura and ecchymosis (23%) which are important signs in hematologic malignancies specially in leukemia .conclusionSkin changes can be the first sign and a mirror of a deeper problem including an internal malignancy. Signs of skin disease may precede, occur with, or follow the detection of an associated cancer. From previous results we conclude that there is high incidence of skin lesions in pediatric patients with hematologic malignancies .The lesions are mainly non-specific and may develop due to chemotherapy , infection by different pathogens , or as paraneoplastic lesions . Many of these lesions may not be detected by patients or by doctors in the pediatric department . In addition to the fact that diagnosis of specific lesions is often established by biopsy of skin lesions. So periodic dermatological evaluation of those patients is very important for early detection and therapy of a possibly cutaneous lesion . Skin involvement may precede recognition of cancer eg. children may present only with purpuric rash or by firm violaceous papules and nodules as in cases of aleukemic leukemia cutis and ask for dermatological advise so physicians must be alert and put in mind the possibility of hematologic malignancy . We hope that awareness of these entities may lead to early detection and improved survival for many patients.
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