We report on five cases of myeloma presenting at a single institution over an 8-year period between 1988 and 1996. All presented with bony pain and a chest wall mass arising from a rib on chest X-ray. Myeloma was not confirmed until 22, 25 and 50 days after admission in three of the cases who each suffered a potentially hazardous percutaneous chest wall biopsy which was undiagnostic. A fourth case did not suffer diagnostic delay as his biopsy showed sheets of plasma cells although, as in all five cases, evidence of myeloma was clearly present on serum/urine electrophoresis, skeletal survey and marrow aspirate, making chest wall biopsy unnecessary. The only case who suffered no diagnostic delay and no percutaneous chest wall biopsy was the only case to have a comprehensive chest X-ray report listing myeloma as a differential diagnosis and suggesting a haematology referral.