<prompt> Multiple punched out lesion in skull is characteristically seen inThalassemiaMultiple MyelomaRicketsOsteoporosis  <response>: Multiple myeloma: 1041 -Davidson 21st editionMULTIPLE MYELOMA - presents as multifocal destructive bone tumours composed of plasma cells throughout the skeletal system The bone lesions appears radiographically as punched out defects usually 1-4 cm in diameter and grossly consists of gelatinous soft red tumour masses Hyperparathyroidism - pepper pot skull, The mandible a common site for brown tumours Moth - eaten appearance - syphilis Rugor Jersy spine - Osteopetrosis Beheaded scortish terrior sign - Spondylolisthesis 