Elderly Woman with Synchronous Triple Malignancies of Small Lymphocytic Lymphoma, Multiple Myeloma and Mucosal Malignant Melanoma

Incidence of multiple synchronous cancers in an individual was perceived to be a rare phenomenon however with improved diagnostic and therapeutic modalities more patients are being diagnosed with synchronous primaries. However these patients represent a therapeutic challenge as no standard guidelines exist; and it is the physician's onus to correctly identify and prioritize treatment based on the expected prognosis and potential for recovery. We present the case of an elderly lady with a complicated clinical scenario where she was diagnosed with SLL/CLL; multiple myeloma and malignant mucosal melanoma; all within the space of a few months. The patient was initially started on chemotherapy for SLL that was subsequently changed to chemotherapy for multiple myeloma and then palliative therapy for melanoma. Patient unfortunately succumbed rapidly to her diseases. This case highlights the fact that that not all laboratory parameters and clinical conditions can be explained by one underlying conditions and physicians need to maintain a high level of suspicion that a patient may have not one but multiple causative etiologies.