David Chen, MD, PhD

Over a lifetime, our skin is exposed to sun, pollution, and other injuries. To survive this damage, skin adapts in surprising ways. It can carry early cancer-causing changes in cells that still look normal, until the right trigger turns them into cancer.This raises a broader question: if skin can hide the seeds of skin cancer, could it also hide a cancer that starts somewhere else? Leukemia is a bone marrow cancer that circulates in blood. Doctors check the bone marrow to see if treatments work, but leukemia can return even when the marrow looks clear. We wondered whether leukemia cells could escape treatment by hiding in skin and later cause relapse.In leukemia patients we studied, we found traces of leukemia in skin that appeared healthy. Patients with more leukemia signal in the skin had worse outcomes. We found that in mice, leukemia cells formed small hidden pockets in the skin and could transmit leukemia through small skin grafts. This gives us a new tool to study how leukemia gets into the skin and how to clear it.This project aims to determine whether leukemia truly hides in normal-looking skin, how it gets there, and whether we can remove it. If successful, the skin could become an easier place to test for hidden leukemia and a gentler target for treatment to help prevent relapse.