<prompt> Punched out appearance in skull seen inMultiple myelomaThalassemiaCarcinoma lungHyperparathyroidism  <response>: i.e. Multiple myeloma: 679-Robbins 7thMULTIPLE 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 Frown tumours Moth - eaten appearance - syphilis Rugor Jersy spine - Osteopetrosis Beheadedscortish terrior sign - Spondylolisthesis 