Multiple myeloma is cancer of monoclonal plasma cells, produces large amounts of IgG (55%) or IgA (25%), high levels of IL-6 may be present. It is the most common primary tumor arising within bone in the elderly. Symptoms are bone pain, hypercalcemia, and renal failure. It has poor prognosis as it may lead to renal insufficiency, ↑susceptibility to infection, anemia, and primary amyloidosis (AL). The skull radiograph shows numerous circular punched-out lytic lesion of the skull bone.