We describe the case of a patient with acute monocytic leukemia who demonstrated striking leukemic infiltration of the abdomen. This cutaneous involvement occurred in association with systemic relapse. Histologic examination of a biopsy specimen of a cutaneous lesion showed a diffuse infiltrate of leukemic cells in the dermis. However, blood vessels and skin adnexa were well-preserved, despite the destructive nature of monocytic leukemia.