Another case of cutaneous involvement in CLL. This punch skin biopsy is from a 67 y/o woman who presented with a large lesion in her lower extremity. CBC showed WBC count of over 200,000 with absolute lymphocytosis. Dermis and subcutaneous tissues show a lymphocytic infiltrate with irregular distribution. A Grenz zone is present. Proliferation centers or reactive lymphoid follicles are not seen. The lymphocytic infiltrate was positive for CD5, CD43, CD20, and CD23. CD10 was negative.