Multiple myeloma isn't typically associated with skin concerns or lesions, but some myeloma patients have been diagnosed with multiple myeloma after a skin issue and these cases should not be overlooked. Every patient matters.
The first group of skin concerns is directly related to multiple myeloma. As we know, multiple myeloma produces an excessive amount of plasma cells. These plasma cells can produce skin manifestations when they colonize the patients’ dermis (the inner layer of the skin). This is called a cutaneous plasmacytoma (which is very rare).
The second group of skin issues represents skin lesions or disorders that are associated with an increased M protein and/or increased levels of monoclonal immunoglobulins, which are key components of multiple myeloma.
A third group of skin issues are reactions to myeloma therapies such as bortezomib and lenalidomide. Some of the skin events reported as side effects of these drugs are rash, mucositis, and edema. (You can learn more about common side effects of myeloma treatment through the HealthTree Cure Hub under Patient Solutions. You can also learn more about other myeloma patients’ journeys with side effects by joining our Community Forums.
Since skin involvement is a rare finding in multiple myeloma, there will be few patients who show skin lesions or disease as the initial presentation of myeloma. That poses a diagnostic challenge for the treating physician because multiple myeloma is not the first diagnosis that comes to mind when the main reason for the medical visit is a skin complaint.
Nevertheless, some of the features that these patients present, and could therefore lead to the diagnosis of multiple myeloma are:
As we are reminded in the article I don’t Have Melanoma, I have Multiple Myeloma people tend to confuse “Multiple Myeloma” with “Melanoma”. They are completely separate cancers: multiple myeloma is a cancer of plasma cells, while melanoma is a cancer of melanocytes (which are the cells that produce the pigment of our skin).
The HealthTree Foundation focuses on Multiple Myeloma NOT Melanoma, however, some studies have investigated the relationship between multiple myeloma and the incidence of skin cancer.
In the article “Secondary malignancies in patients with multiple myeloma, Waldenstrom macroglobulinemia and monoclonal gammopathy of undetermined significance” results support conflicting but generally supportive information about an increased risk of secondary cancers (skin cancer included) in patients with Multiple Myeloma.
The bottom line is that multiple myeloma and myeloma treatment can increase the risk of some infections and additional primary malignancies. Some studies have investigated the relationship between multiple myeloma and the risk of skin cancer. While further research needs to be done regarding these associations, prevention is key.
For patients using the Real World Evidence portal called the HealthTree Cure Hub, 699 myeloma patients reported having a secondary cancer, melanoma being 15% of the secondary cancers. To put this into perspective, the incidence rate of melanoma of the skin in the US standard population is .02%, as reported by the American Cancer Society.
Skin cancer prevention is a top public health priority for the American Academy of Dermatology Association.
One of the major risk factors for skin cancer is unprotected exposure to the sun’s UV rays. Therefore, prevention starts by tackling this key risk factor.
You can take action for prevention by doing the following:
1 Harati A, Brockmeyer NH, Altmeyer P, Kreuter A. Skin disorders in association with monoclonal gammopathies. Eur J Med Res. 2005 Mar 29;10(3):93-104. PMID: 15851375.
3 Patrizi A, Venturi M, Dika E, Maibach H, Tacchetti P, Brandi G. Cutaneous adverse reactions linked to targeted anticancer therapies bortezomib and lenalidomide for multiple myeloma: new drugs, old side effects. Cutan Ocul Toxicol. 2014 Mar;33(1):1-6. doi: 10.3109/15569527.2013.787086. Epub 2013 May 2. PMID: 23638756.
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5 Behera B, Pattnaik M, Sahu B, Mohanty P, Jena S, Mohapatra L. Cutaneous Manifestations of Multiple Myeloma. Indian J Dermatol. 2016 Nov-Dec;61(6):668-671. doi: 10.4103/0019-5154.193682. PMID: 27904188; PMCID: PMC5122285.
9 Castillo JJ, Gertz MA. Secondary malignancies in patients with multiple myeloma, Waldenström macroglobulinemia and monoclonal gammopathy of undetermined significance. Leuk Lymphoma. 2017 Apr;58(4):773-780. doi: 10.1080/10428194.2016.1217527. Epub 2016 Aug 22. PMID: 27546465.
10 Razavi P, Rand KA, Cozen W, et al. Patterns of second primary malignancy risk in multiple myeloma patients before and after the introduction of novel therapeutics. Blood Cancer J. 2013;3:e121.
11 Mailankody S, Pfeiffer RM, Kristinsson SY, et al. Risk of acute myeloid leukemia and myelodysplastic syndromes after multiple myeloma and its precursor disease (MGUS). Blood. 2011;118:4086–4092.
12 Castillo JJ, Gertz MA. Secondary malignancies in patients with multiple myeloma, Waldenström macroglobulinemia and monoclonal gammopathy of undetermined significance. Leuk Lymphoma. 2017 Apr;58(4):773-780. doi: 10.1080/10428194.2016.1217527. Epub 2016 Aug 22. PMID: 27546465.
15 Robinson AA, Wang J, Vardanyan S, Madden EK, Hebroni F, Udd KA, Spektor TM, Nosrati JD, Kitto AZ, Zahab M, Cheema S, Fors DH, Norberg A, Diehl J, Waterman GN, Swift RA, Crowley J, Berenson JR. Risk of skin cancer in multiple myeloma patients: a retrospective cohort study. Eur J Haematol. 2016 Nov;97(5):439-444. doi: 10.1111/ejh.12748. Epub 2016 Mar 7. PMID: 26872804.
16 Yang J, Terebelo HR, Zonder JA. Secondary primary malignancies in multiple myeloma: an old NEMESIS revisited. Adv Hematol. 2012;2012:801495. Epub 2012 Jul 19.
about the author
Patricia is an International Medical Graduate who joined HealthTree in 2020 as part of the Patient Experience team. She helps patients understand and track their lab & genetic test results as well as relevant information from their health history. She loves ballet, traveling, and reading a good science fiction book as often as possible.