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ObjectiveThe authors determined the roles of the physician and the patient in melanoma recurrence detection. MethodsThe University of Alabama Melanoma Registry, consisting of 1475 patients surgically treated for cutaneous melanoma from 1958 to 1984, was searched to find 195 evaluable cases of melanoma recurrence. Patients were grouped by the type of return visit. Group returned on a previously determined date, whereas group 11 returned before the scheduled visit. ResultsSymptoms of recurrence were present in 90% of group patients and 93% of group 11 and correlated with the site of recurrence in more than two thirds of cases. Recurrence sites were local, regional, and distant in 35%, 31%, and 29% of group 1, respectively, and 42%, 25%, and 29% of group 11. The median interval to recurrence was 24.2 months in group and 37.7 months in group 11 (p = 0.059). Median overall survival was 57 months in group and 62 months in Group II (p = 0.210). ConclusionsSymptoms are present in 90% of the patients with recurrent melanoma and accurately predict the site of recurrence. Overall survival is not affected by the type of patient return visit.The annual incidence of melanoma is rising such that the risk of developing melanoma is estimated to be 1:75 by the year 2000.1,2 This alarming statistic is accompanied by a trend toward thinner and, thus, better prognosis melanomas. Currently, more than 80% of patients surgically treated for cutaneous melanoma are cured.3Postoperative surveillance for malignancy is directed toward detection ofrecurrence, identification of new primary neoplasms, and patient reassurance. Controversy exists regarding follow-up of patients with more common malignancies such as breast carcinoma, because detection of asymptomatic recurrence adds little to overall survival in several reports.48 The long-term, disease-free survival of patients with metastatic melanoma is low, even when the recurrence is resectable or treated with chemotherapy.9"0Much is known about the pattern and timing of recurrence in cutaneous melanoma, but there is little reported about the most efficient method of detection.'-16 The purpose of this study was to evaluate the patient's and physician's roles in the detection of recurrent melanoma and their influence on survival.

Appropriate selection of cases for core biopsy can more than double the yield of cancer in NLB samples without a decrease in the percentage of small cancers detected.

Background. Complete surgical resection of locally advanced primary and recurrent rectal cancer is often incomplete. Improved tumor downstaging may improve resection rates and local control if postoperative morbidity is not increased. Methods. The clinical and pathologic records of 119 patients with locally advanced primary and recurrent rectal carcinoma were reviewed to determine the effect of preoperative chemoradiation on postoperative morbidity compared with a control group treated with external beam radiation therapy alone. Group I (56 patients) was treated with 45 Gy of external beam radiation therapy. Group II (63 patients) received 45 Gy of external beam radiation therapy with continuous‐infusion cisplatin, 5‐fluorouracil, or both. Results. Forty‐one patients (73.2%) in Group I and 48 in Group II (76.1%) underwent surgical resection. Anal‐sparing procedures were performed more frequently in Group II (25%) than in Group I (5.3%, P < 0.05). The overall complication rate for Group I was 51% versus 44% for Group II (P < 0.05) or 1.17 complications per patient in Group I and 0.58 complications per patient in Group II. One patient in each group died of treatment‐related septic complications. Conclusions. It was concluded that the addition of chemotherapy to radiation to treat rectal carcinoma does not result in an increased operative morbidity and may contribute to a higher proportion of patients being treated with anal–rectal‐conserving surgical procedures.