Cutaneous spicules are a characteristic paraneoplastic sign for multiple myeloma.1- 4 These spicules are composed of the monoclonal protein present in the patient's serum.4 Cutaneous spicules of the scalp have been reported, but to the best of our knowledge have not been biochemically investigated.2 Herein, we describe a patient with multiple myeloma who was seen with cutaneous spicules on the nose and hair casts. Biochemical analysis demonstrated the presence of the patient's serum monoclonal protein in the cutaneous spicules and hair casts. We propose that hair casts should be recognized as a characteristic finding along with cutaneous spicules in patients with multiple myeloma.
Miller JJ, Anderson BE, Ioffreda MD, Bongiovanni MB, Fogelberg AC. Hair Casts and Cutaneous Spicules in Multiple Myeloma. Arch Dermatol. 2006;142(12):1650-1666. doi:10.1001/archderm.142.12.1665