Early signs and symptoms of leukemia in children can include skin changes. Knowing the signs can help parents get care soon.

Story by: Kim Huston on May 28, 2021

Leukemia is the most common cancer that affects children, with 1 in 3 children with cancer experiencing leukemia. Skin changes can be a symptom in early stage leukemia. Here is what parents should know and look for with skin changes in early stage leukemia.

Skin symptoms of leukemia in children

Bone marrow produces most of the body’s blood cells, including red blood cells, white blood cells and platelets. Since leukemia is a cancer of the blood-forming tissue called bone marrow, many early signs of leukemia often are related to the bone marrow. The abnormal leukemia cells, called blasts, begin to reproduce and crowd out the healthy blood cells created by the bone marrow. When this happens, symptoms emerge, with some being visible in the skin, including:

• Pale skin: This happens when anemia occurs, when the blasts are crowding out healthy blood cells. Pale skin may be one sign of anemia; a child also can feel tired or have changes in breathing due to the low red blood cell count.
• Bruising: When platelets are crowded out by blasts, it can cause unexplained bruising and bleeding. Bruises can appear without an apparent cause, especially on the legs and arms.
• Spots that look like a rash: Low platelet count also can cause small round spots, called petechiae, that look like a rash. The spots are usually small and cause no itching or pain like rashes often do. The petechiae are usually noticed on the legs, close to the ankles. Petechiae occur when very small blood vessels have leaked blood.

Other leukemia signs in children

It’s important to know that these symptoms can resemble other blood disorders or be related to other medical conditions. Other leukemia symptoms can include:

• Recurring infection: Children with leukemia can experience an usually high number of white blood cells — they are immature cells and not as good at fighting infection. Because of this, children with leukemia can experience many viral or bacterial infections or take a really long time to get over infections.
• Pain in the abdomen: Blasts can collect in the organs, including the kidneys, liver and spleen, causing them to enlarge. A child may lose their appetite and lose weight due to abdominal pain.
• Lymph nodes swelling: The lymph nodes under the arms, in the groin or in the neck are responsible for filtering the blood. When blasts collect in the nodes, they begin to swell or become larger in children with leukemia.
• Difficulty breathing: The blasts can clump around the thymus, an organ behind the breastbone. The mass of cells can cause chest pain and difficulty breathing. A child with leukemia may experience wheezing, coughing and/or pain when breathing.
• Gum problems: Children with leukemia may experience swelling, pain or bleeding in the gums.
• Bone or joint pain: This can be caused by a buildup of blasts near a bone’s surface or inside of a joint.

“By far, it’s important for parents to know that the most common causes of pallor, bruising and petechiae are not leukemia,” said Esther E. Knapp, M.D., pediatric hematologist/oncologist with Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine. “Skin changes are only a small part of the overall clinical picture when a patient typically presents with leukemia. If parents notice any symptoms or changes in their child’s health, they should consult their child’s pediatrician for evaluation.”