Malignancy affecting the musculoskeletal system falls broadly into two main categories. These are primary and metastatic disease. Malignancy of any kind should always be at the back of your mind as a differential diagnosis as the consequences of missing the diagnosis are potentially devastating.

Metastatic Disease

Metastatic disease is the most common form of malignant bone disease. It can arise from a number of primary sites and can spread to bone via a number of mechanisms. Watch the video on metastatic bone lesions. The Mirels' score is used to classify the likelihood of impending fracture. Follow to link to see the paper on this classification system.

Book chapter



Myeloma is a malignancy of plasma cells which leads to widespread bony lytic lesions. It is an important differential diagnosis to have in mind as its symptoms can be varied and widespread.

Book chapter


Primary Disease

Primary bone tumours are very uncommon with only around 500 occurring each year in the UK. The two commonest types of malignant tumour are osteosarcoma and chondrosarcoma. There are many other types but only a basic knowledge is required at undergraduate level.

Primary Disease <Link to follow>