Case series
Patient one was a five-year-old Caucasian boy diagnosed with pre-B ALL
in 2013 and treated as per the UKALL 2011 protocol regimen A. This
regimen includes dexamethasone, vincristine, pegaspargase, methotrexate,
mercaptopurine, doxorubicin, cyclophosphamide, and cytarabine. Following
cessation of chemotherapy in 2016, multiple small brown macules were
noted on the palmar and plantar surfaces of hands and feet (Figure 1).
These have persisted for over four years.
Patient two was a nine-year-old Caucasian boy diagnosed with pre-B ALL
in 2017 and treated as per the COG ALL 1131 protocol. This regimen
includes prednisolone, vincristine, pegaspargase, methotrexate,
mercaptopurine, anthracyclines, cyclophosphamide, and cytarabine. During
maintenance chemotherapy in 2020, multiple small brown macules were
noted on the dorsal surfaces of fingers and feet (Figure 2).
Patient three was a seven-year-old Caucasian boy diagnosed with pre-B
ALL in 2018 and treated as per the UKALL 2011 protocol regimen A. During
maintenance chemotherapy in 2020, multiple small brown macules were
noted on the palmar and plantar surfaces of hands and feet, as well as
extensive macules on the trunk (Figure 3).