<prompt> Multiple punched out lesions in soft skull are seen inMultiple myelomaSecondariesMalignancyMedulloblastoma  <response>: Multiple myeloma 191-92-AMetastatic bone disease - Moth eaten appearance in the cortexMultiple myeloma - reduction in density, myeloma is one of the commonest cause of secondary osteoporosis and vertebral compression fracture Multiple punched-out defect with no marginal new bone around them 