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).