Recurrent CLL in the skin versus a bug bite

The second deeper analysis of my skin biopsy was read, some would say, grossly over read, as consistent with recurrence CLL. Seems like the biopsy was filled with dense infiltrates of slight small atypical lymphocytes. Cancerous B cells perhaps? The third step, now pending, is cytogenetics to look for the dreaded clonality of my B lymphocytes.

Sounds grim.

Before measuring myself for a coffin as the prognosis for leukemia cutis can be pretty bleak, I took a step back and had a friend, a very smart dermatopathologist review the report and he thinks is a classic arthropod bite, completely a benign process, and even shows what a good immune system I have in sending all those lymphocytes to the site of the insult. He is pissed off big time at the overreach of the rare and scary CLL skin diagnosis and the unwillingness to consider a far more common and obvious diagnosis, a bug bite.

Even the fear triggering doctors says it likely that the particular cells I recruit to fight off an insult to my skin simply reflect my particular CLL lymphocyte population. That there is no actual malignant tumor, no leukemia of the skin. Ho. Hum.

I don't buy even that. My absolute lymphocyte count is only 0.7, below normal, and I bet most of that is T cells after all the rituximab last year cleaned out my B cells. I bet my cytogenetics in the skin will also show T cells, no B clones.

If you closed your eyes on some of the turns and spins during this roller coaster ride and are now lost, let me summarize.

I believe this whole CLL in the skin thing is an over reaction, because everyone is so scared to miss a cancer on a doctor who already has cancer. You never get sued for over diagnosing. You just worry the patient and run up big bills.

And besides, my boo boo is healing up with bactroban ointment. Almost gone. Hardly cancer like behavior.

Forman isn't worried. I too refuse to worry about this one.

It wouldn't be CLL if there was agreement between any two of my doctors.

Bone marrow report next week. I can hardly wait.