Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a recently described, rare hematologic malignancy with prominent skin involvement. The prognosis of this disease is poor in most cases, with rapid progression despite chemotherapy administration. The first reported case of this disease was in 1994, and less than 200 cases worldwide have been described in the literature to date. Moreover coexistence of BPDCN and MDS is extremely rare. In this study, we describe a typical patient with BPDCN in China who presented with cutaneous involvement as the first manifestation associated with MDS; a brief review of literature is also given.