The abrupt onset of widespread cutaneous eruptions prompted a 66-year-old man to seek medical evaluation. The patient had had chronic myelogenous leukemia for 5 years. Dr Ted Rosen of Houston writes that purpuric patches, papules, and nodules were noted on the patient’s back and shoulders. Despite administration of hydroxyurea, his white blood cell count had risen recently from 25,000/μL to nearly 60,000/μL, and his spleen had enlarged. Skin biopsies from 3 different morphologic types of lesions revealed dermal and subcutaneous infiltration of mature and immature neutrophils, which confirmed the diagnosis of leukemia cutis. Skin involvement during chronic myelogenous leukemia is rare and often precedes preterminal transformation into blastic crisis. Despite alterations in the patient’s chemotherapeutic regimen, he died of refractory disease 3 months later.