A 73-year-old woman was referred by her hematologist for cholestasis of unknown origin. She was recently diagnosed with chronic myelomonocytic leukemia grade 0 in a context of fatigue, night sweats, weight loss and monocytosis. A PET-CT showed hepatosplenomegaly and multiple centimetric adenopathy. The diagnosis was confirmed by a bone marrow aspiration and biopsy. Interestingly, the evolution of the patient is marked by the appearance of cholestasis and an erythematous firm skin nodule of the right forearm. The skin lesion was biopsied to rule out a cutaneous localization of the patient’s known hemopathy.