Our patient’s epidermal lacunae did not stain with CD31, similarly to the patient with leukemia who also presented with acral angiokeratoma-like lesions2; however, there was CD31 staining of the vascular component arising from the papillary dermis, reinforcing that the lesions observed were vascular in origin despite not staining throughout the epidermal component as a true angiokeratoma would stain. This evidence concerns the gene PECAM1 and leukemia.