To determine the incidence and course of multiple myeloma (MM) in the Afro-Caribbean population of Curaçao, we studied all MM patients discharged from the only hospital on the island during an 11-year period starting in 1980. As 50 patients fulfilled the diagnostic criteria for MM proposed by Durie, the average annual incidence (AI) of MM was estimated at 3.1/100,000 person years; AI was similar in males and females, but showed a steep increase with age in both sexes; 10% of all MM patients were < 40 years of age. At diagnosis 68% of patients were in Stage III, in 26% serum creatinine levels were > 20 mg/l, 36% had hypercalcaemia, and 50% had multiple bone lesions. Median survival was 20.5 months; Stage III myeloma and bone marrow plasma cell percentage > 50 were independent risk factors for poor survival. Infections were the immediate cause of death in 54% of the non-survivors. We conclude that the incidence rate of MM in the Afro-Caribbean population of Curaçao is one of the lowest reported in black populations; however, the presentation and course of MM follow the pattern seen in most other countries.