The initial features of acute myeloid leukemia in a previously well 10-year-old girl consisted of cellulitic lesions on the face and limbs. These lesions subsequently progressed, with superimposed blistering and pustulation. They were painful and tender. The condition did not respond to systemic broad-spectrum antibiotic therapy. Skin biopsy showed an intense, dermal neutrophilic infiltrate without additional evidence of infection or leukemic deposits. The cutaneous lesions responded promptly to high-dose systemic corticosteroids, and the leukemia to chemotherapy.