mGODS - Monoclonal Gammopathies Of Dermatological Significance

Harvard Dermatology
Pearls for working up monclonal gammopathies in setting of dermatological disease

David M. Miller


May 6, 2022


Overview & Learning Objectives
Pre-Lecture Questions 

Case 1
Additional Pre-Lecture Questions

Plasma Cell Dyscrasias
Detection and Identification of Monoclonal Proteins

Overview & Learning Objectives

Here, we provide a primer for that lecture. We start with a clinical case and some discrete questions so that you can think through them ahead of the lecture. We will go through these as a group on Thursday.

Pre-Lecture Questions



Case 1 Clinical Questions:

  • What does this part of the work up mean?
    • SPEP demonstrated abnormal band in gamma region
      • Identified by IFE as IgG Kappa
      • Represents by densitometry 10% (730 mg/dL) of total protein
  • What are you next steps in management?
  • While referral to hematology is never the wrong answer, if you wanted to pursue additional work up, what would be your next steps?

Additional Pre-Lecture Questions

  • True or False: An SPEP will both quantitate the M protein and identify the heavy and light chain associated with it?
  • True or False: A Bone Marrow Biopsy is recommended in all patients with an MGUS?
  • Myeloma is typically associated with: osteoblastic lesions or osteolytic lesions?
  • Which of the following is the most appropriate screening test(s) for the vast majority of plasma cell dyscrasias?
    • SPEP
    • SPEP + sFLC
    • SPEP + sIFE
    • SPEP + sFLC + sIFE
    • SPEP + sIFE + uPEP/IFE
    • SPEP, sFLC, sIFE, uPEP/IFE

Plasma Cell Dyscrasias


Plasma Cell Development

Monoclonal Gammapathies

Detection and Identification of Monoclonal Proteins


Take Home Points on Interrogating the Monoclonal Protein


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  1. Shalhout et al. Generalized Acquired Cutis Laxa Associated with Monoclonal Gammopathy of Dermatological Significance. Case Reports in Dermatological Medicine. 2020↩︎

  2. Katzmann JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev. 2009;30(3):105-111.↩︎

  3. Waldenstrom J. Studies on conditions associated with disturbed gamma globulin formation (gammopathies). Harvey Lect. 1960;56:211-231.↩︎

  4. Kyle RA. Monoclonal gammopathy of undetermined significance. Natural history in 241 cases. Am J Med. 1978;64(5):814-826.↩︎

  5. Katzmann JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev. 2009;30(3):105-111.↩︎