Eruptive ulcerative follicular spicules heralding progression of smoldering multiple myeloma

Abstract

Herein, we describe a patient with immunoglobulin G (IgG)-lambda smoldering multiple myeloma with translocation t(4:14) who developed widespread ulcerative hornylike spicules, heralding rapid progression to overt myeloma requiring aggressive chemotherapy and autologous stem cell transplantation. The serum abnormal immu-

Spiny Keratoderma in Association with Melanoma

“…Taking into consideration the differences in SK distribution in relation to types of associated malignancies, it is plausible that mechanisms of SK appearance differ in visceral and hematologic malignancies. This is supported by the finding of monoclonal immunoglobulin deposition within the epidermis, at the dermo–epidermal junction and in hyperkeratotic spicules in SK lesions associated solely with multiple myeloma [ 16 , 22 , 23 ].…”

“…It appears that certain malignant conditions are associated with particular patterns of SK [ 7 , 16 , 22 ]. Those with visceral malignancies tend to have peripheral distribution of skin lesions on the palms and soles, while those with multiple myeloma and monoclonal gammopathy display central distribution of the lesions on the face and trunk [ 14 , 17 ].…”

“…In addition, SK is observed to appear in association with various conditions, notably autosomal dominant polycystic kidney disease, Darier's disease, type II diabetes, asthma and type IV hyperlipoproteinemia [9][10][11][12][13]. SK has also been observed in association with several malignancies, including lymphoma, multiple myeloma, myelofibrosis, melanoma and breast, renal, rectal, bronchial, gingival carcinoma, ovarian carcinoma and other malignancies [6,7,[14][15][16][17][18][19][20][21][22]. Hence, there is a growing tendency to view SK as a paraneoplastic phenomenon.…”

Facial Spinulate Demodicosis

“…In 1944, Heidenström et al 4 described follicular hyperkeratotic spicules as a rare, but highly characteristic, dermatosis that is associated with multiple myeloma. Subsequently, Tomasini et al 22 described eruptive ulcerative follicular spicules heralding the progression of active multiple myeloma. Another entity, the case of multiple minute digitate hyperkeratoses, was described by Caccetta et al 9 Multiple minute digitate hyperkeratoses is predominantly a non-follicular digitate keratosis affecting the trunk and the limbs, while the face and palmoplantar surfaces are not affected.…”