Abstract: There are few case reports of acute monocytic leukemia with multiple papules and nodules as the initial manifestation and a definite diagnosis by skin biopsy or bone marrow biopsy. The patient with acute monocytic leukemia presented with dark red macules, papules, and nodules ranging from mung beans to nail LIDS were found all over the body at the time of admission, and mung beans sized red granulomatous hyperplasia was found on the inner eyelid margin of both eyes. There was no obvious abnormality in blood parameters, only the proportion of monocytes was increased. It is suggested that dermatologists should take into account the early atypical blood changes of hematological tumors in combination with clinical manifestations of skin lesions.