It is unusual for multiple le myeloma to occur initially with cutaneous involvement. When it occurs, cutaneous extension from underlying osseous lesions is the usual cause. Lesions without adjacent bone involvement are rare. We report here a case with multiple cutaneous plasmacytomas, repeatedly normal findings from bone marrow studies, and multiple destructive lesions of the long bones. The immunoperoxidase technique showed specific staining of neoplastic plasma cells for IgAλ, and serum immunoelectrophoresis detected the same immunoglobulin.
Report of a Case
A 58-year-old man was hospitalized with swelling of the right calf, multiple skin nodules, anorexia, and an 18-kg weight loss of nine weeks' duration.The patient was cachectic and had multiple, firm, fixed, nontender subcutaneous nodules varying from 4 to 10 cm on the left foot (Fig 1), left axilla, right shoulder, and back, with some erythema and increased venous markings, and an enlarged (10-cm) right testicle.Pertinent laboratory data