Ulcerating yellow plaques on the legs

Abstract

A woman in her sixties with a 25-year history of multiple myeloma presented with yellow-orange plaques on her lower extremities. The plaques waxed and waned for years without associated pain or pruritus, but recently they became painful and ulcerated, thus prompting evaluation by dermatology (Figs 1 and 2). Treatments previously administered for multiple myeloma, including corticosteroids, stem cell transplantation, immunotherapy, and chemotherapy, had variable effects on the lesions. Treatment for multiple myeloma had been suspended because her disease was stable and there was concern that the skin progression could represent an adverse effect. An incisional biopsy for histologic examination was performed, with representative sections shown (Fig 3).