Abstract
There is paucity of data regarding the diagnostic yield and safety of skin biopsies in patients with acute myeloid leukemia (AML), though skin eruptions are common in these patients. We evaluated 216 patients treated in our hemato-oncology unit at a tertiary medical center between 2007 and 2018 and identified 35 patients who underwent 37 skin biopsies. The majority of biopsies were performed during induction treatment for AML (n = 26, 70%), whereas the remainder of biopsies were done prior to induction initiation (n = 8, 22%) or during consolidation chemotherapy (n = 3, 8%). Pathology findings were inconclusive in 13 cases (35%), while diagnostic biopsies were positive for drug eruptions (24%), leukemia cutis (16%), infections (11%), reactive processes (8%) and Sweet syndrome (5.5%). In almost half of cases (16/37) tissue cultures were performed. Of those, only a quarter (4/16) were positive. Histopathology and tissue culture results altered immediate patient care in 3 cases (8%), yet information obtained from biopsies had potential to affect long term patient care in 8 additional cases (21.6%). Although most skin biopsies were performed while patients had severe thrombocytopenia and neutropenia, only one patient had a complication due to the biopsy (fever and local bleeding). With the limitation of a retrospective analysis, our study suggests that skin biopsies in patients treated for AML are relatively safe. Although biopsy results infrequently alter immediate patient management, long term effect on patient care expand the potential diagnostic yield of skin biopsies.
Highlights
There is paucity of data regarding the diagnostic yield and safety of skin biopsies in patients with acute myeloid leukemia (AML), though skin eruptions are common in these patients
We recorded whether the results had an impact on patient care, i.e.: (1) a change in antimicrobial coverage to treat a new pathogen recovered from the skin biopsy culture, (2) a diagnosis of leukemia cutis in a patient with no other evidence of leukemia, (3) initiation of steroid therapy in response to a biopsy results suggestive of an inflammatory or hypersensitivity reaction such as Sweet syndrome or drug reaction, (4) a culprit drug discontinuation in response to a diagnosis of drug reaction in skin biopsy
Of the 216 consecutive patients diagnosed with AML at our institute during the study period, 35 developed a rash during treatment and underwent skin biopsy
Summary
There is paucity of data regarding the diagnostic yield and safety of skin biopsies in patients with acute myeloid leukemia (AML), though skin eruptions are common in these patients. Skin eruptions in patients with AML, both at presentation and during treatment, are commonly encountered in clinical practice They may be drug-related or reactive rashes or due to infections, leukemia cutis, Sweet syndrome, or neutrophilic eccrine h idradenitis[3,4,5,6,7,8,9,10]. The aim of this study was to evaluate the diagnostic yield and safety of skin biopsies obtained from adult patients with AML during hospitalization for intensive chemotherapy
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