A 57-year-old white man clinically had acute guttate psoriasis and increasing weakness. However, histopathologic review of the skin biopsy specimen and bone marrow aspiration revealed leukemia cutis and acute myelomonocytic leukemia, respectively. To our knowledge, the clinical presentation of leukemia cutis as guttate psoriasis has not been previously reported. Other cutaneous manifestations of acute monocytic leukemia are reviewed.