Volume 27 Number 6, Part 1 December 1992
Correspondence
2. Stein DJ. Schemas in the cognitiveand clinicalsciences:an integrative construct. J Psychotherapy Integration 1992; 2:45-63. 3. Stein DJ, Hollander E. Cognitive science and obsessivecompulsive disorder. In: Stein D J, Young JE, eds. Cognitive science and clinical disorders. San Diego: Academic Press, (In press.) 4. Hollander E, DeCaria CM, Schneier FR, et al. Fenfluramine augmentation of serotonin reuptake blockade antiobsessional treatment. J Clin Psychiatry 1990;5l:l 19-
23. 5. Stein DJ, Hollander E. Low-dose pimozide augmentation of serotoninreuptake blockers in the treatment of trichotillomania. J Clin Psychiatry (In press.) 6. Leonard HL. Drug treatment of obsessive-compulsivedisorder. In: Rapoport JL, ed. Obsessive-compulsivedisorder in children and adolescents. Washington, DC: American Psychiatric Association, 1989:217-36. 7. Leonard HL, Swedo SE, Rapoport JL, et al. Treatment of childhoodobsessivecompulsivedisorder with clomipramine and desipramine: a double-blind crossover comparison. Arch Gen Psychiatry 1989;46:1088-92. 8. Behavior therapy for obsessive-compulsivedisorder. In: Jenike MA, Baer L, Minichiello WE, eds. Obsessive-compulsive disorders. 2nd ed. Chicago: Year Book, 1990. 9. Friman PC, Finney JW, Christophersen ER. Behavioral treatment of trichotillomania: an evaluative review. Behav Ther 1984;15:249-64. 10. Young JE. Cognitive therapy for personality disorders. Sarasota, Fla: Practitioner's Resource Exchange, 1990.
Multiple adnexal tumors and a parotid basal cell adenoma
To the Editor: We have read with interest the article "Multiple Adnexal Tumors and a Parotid Basal Cell Adenoma" (J AM ACAD DERMATOL 1991;25:960-4). We and other authors have reported similar cases.l3 We befieve that more than a fortuitous association exists between multiple cutaneous adnexal tumors (cylindromas, trichoepitheliomas) and salivary gland tumors (particularly of the parotid gland). However, more cases need to be studied to define these associations as a new clinical syndrome. We believe that parotid echography and computed tomographic scans should be routinely done on patients with multiple adnexal tumors and their close relatives should be examined periodically. Luis D. Sevinsky, AID Zitka Bus[in, MD Marta Cohen, MD Cristina Kien, MD Horacio Cabo, MD Division of Dermatology, University Hospital "Josh de San Martin," Cordoba 2351, CP 1120, Buenos Aires, Argentina
1035
REFERENCES 1. Headington JT, Batsakis JG, Beals TF, et al. Membranous basal celladenoma of the parotid gland, dermal eylindrom~s and trichoepitheliomas.Cancer 1977;39:2460-9. 2. Bustin Z, Sevinsky LD, Cohen M, et al. Cilindromas y trieoepiteliomas multiples asociados a tumor maligno de parr[ida: Un nuevo sindrome? Arch Argent Dermatol 1988; 38:389-96. 3. Roekerbie N, Solomon AR, Woo TY, et al. Malignant dermal cylindroma in a patient with multiple derma[ eylindromas, tfichoepitheliomas,and bilateral dermal analogue tumors of the parotid gland. Am J Dermatopathol 1989; 11:353-9.
Underreporting of cutaneous melanoma in cancer registries nationwide
To the Editor: Recent reports in two states have documented underreporting of cutaneous melanoma incidence attributable to increasing numbers of cases diagnosed at outpatient clinics, which are not always required to report to population-based cancer registries. The documented case-ascertainment rate for all cancers in Surveillance, Epidemiology and End Results (SEER) areas is about 95% to 98%. However, Karagas et al. I found melanoma underreporting in Washington increased from 2% in 1974 to 21% in 1984. In addition, Koh et al. 2 estimated cutaneons melanoma underreporting in Massachusetts to be 12% to 19% in the period of 1982 to 1986. We surveyed all 39 cancer registries across the country to gauge the extent of cutaneous melanoma underreporting; 33 (85%) responded to our mailed questionnaire, and 11 responded with an estimate of the melanoma underreporting they had documented in their areas (20 others thought melanoma underreporting was a problem, but had no data). In Puerto Rico, California, Colorado, Connecticut, Iowa, Michigan, Missouri, New Hampshire, Rhode Island, Texas, and Wyoming, the distribution of estimated underreporting rates was: 1% to 9% (four states); 10% to 14% (three); 15% to 19% (three); and 20% to 24% (one). Almost all respondents indicated that private physicians performing office-based biopsies or the use of nonhospital-based dermatopathology laboratories (or out-ofstate laboratories) was the source of unreported cases. We asked for data on invasive melanoma only; a recent report from Northern California also notes reporting problems with in situ melanoma) Seventeen of the 33 registries (52%) had taken steps to remedy this problem, using surveys and letters to private dermatologists and pathology laboratories, active casefinding at outpatient laboratories and clinics, and legislation to promote reporting from nonhospital laboratories, All 3 3 areas had laws mandating the reporting of hospi-
Correspondence
2. Stein DJ. Schemas in the cognitiveand clinicalsciences:an integrative construct. J Psychotherapy Integration 1992; 2:45-63. 3. Stein DJ, Hollander E. Cognitive science and obsessivecompulsive disorder. In: Stein D J, Young JE, eds. Cognitive science and clinical disorders. San Diego: Academic Press, (In press.) 4. Hollander E, DeCaria CM, Schneier FR, et al. Fenfluramine augmentation of serotonin reuptake blockade antiobsessional treatment. J Clin Psychiatry 1990;5l:l 19-
23. 5. Stein DJ, Hollander E. Low-dose pimozide augmentation of serotoninreuptake blockers in the treatment of trichotillomania. J Clin Psychiatry (In press.) 6. Leonard HL. Drug treatment of obsessive-compulsivedisorder. In: Rapoport JL, ed. Obsessive-compulsivedisorder in children and adolescents. Washington, DC: American Psychiatric Association, 1989:217-36. 7. Leonard HL, Swedo SE, Rapoport JL, et al. Treatment of childhoodobsessivecompulsivedisorder with clomipramine and desipramine: a double-blind crossover comparison. Arch Gen Psychiatry 1989;46:1088-92. 8. Behavior therapy for obsessive-compulsivedisorder. In: Jenike MA, Baer L, Minichiello WE, eds. Obsessive-compulsive disorders. 2nd ed. Chicago: Year Book, 1990. 9. Friman PC, Finney JW, Christophersen ER. Behavioral treatment of trichotillomania: an evaluative review. Behav Ther 1984;15:249-64. 10. Young JE. Cognitive therapy for personality disorders. Sarasota, Fla: Practitioner's Resource Exchange, 1990.
Multiple adnexal tumors and a parotid basal cell adenoma
To the Editor: We have read with interest the article "Multiple Adnexal Tumors and a Parotid Basal Cell Adenoma" (J AM ACAD DERMATOL 1991;25:960-4). We and other authors have reported similar cases.l3 We befieve that more than a fortuitous association exists between multiple cutaneous adnexal tumors (cylindromas, trichoepitheliomas) and salivary gland tumors (particularly of the parotid gland). However, more cases need to be studied to define these associations as a new clinical syndrome. We believe that parotid echography and computed tomographic scans should be routinely done on patients with multiple adnexal tumors and their close relatives should be examined periodically. Luis D. Sevinsky, AID Zitka Bus[in, MD Marta Cohen, MD Cristina Kien, MD Horacio Cabo, MD Division of Dermatology, University Hospital "Josh de San Martin," Cordoba 2351, CP 1120, Buenos Aires, Argentina
1035
REFERENCES 1. Headington JT, Batsakis JG, Beals TF, et al. Membranous basal celladenoma of the parotid gland, dermal eylindrom~s and trichoepitheliomas.Cancer 1977;39:2460-9. 2. Bustin Z, Sevinsky LD, Cohen M, et al. Cilindromas y trieoepiteliomas multiples asociados a tumor maligno de parr[ida: Un nuevo sindrome? Arch Argent Dermatol 1988; 38:389-96. 3. Roekerbie N, Solomon AR, Woo TY, et al. Malignant dermal cylindroma in a patient with multiple derma[ eylindromas, tfichoepitheliomas,and bilateral dermal analogue tumors of the parotid gland. Am J Dermatopathol 1989; 11:353-9.
Underreporting of cutaneous melanoma in cancer registries nationwide
To the Editor: Recent reports in two states have documented underreporting of cutaneous melanoma incidence attributable to increasing numbers of cases diagnosed at outpatient clinics, which are not always required to report to population-based cancer registries. The documented case-ascertainment rate for all cancers in Surveillance, Epidemiology and End Results (SEER) areas is about 95% to 98%. However, Karagas et al. I found melanoma underreporting in Washington increased from 2% in 1974 to 21% in 1984. In addition, Koh et al. 2 estimated cutaneons melanoma underreporting in Massachusetts to be 12% to 19% in the period of 1982 to 1986. We surveyed all 39 cancer registries across the country to gauge the extent of cutaneous melanoma underreporting; 33 (85%) responded to our mailed questionnaire, and 11 responded with an estimate of the melanoma underreporting they had documented in their areas (20 others thought melanoma underreporting was a problem, but had no data). In Puerto Rico, California, Colorado, Connecticut, Iowa, Michigan, Missouri, New Hampshire, Rhode Island, Texas, and Wyoming, the distribution of estimated underreporting rates was: 1% to 9% (four states); 10% to 14% (three); 15% to 19% (three); and 20% to 24% (one). Almost all respondents indicated that private physicians performing office-based biopsies or the use of nonhospital-based dermatopathology laboratories (or out-ofstate laboratories) was the source of unreported cases. We asked for data on invasive melanoma only; a recent report from Northern California also notes reporting problems with in situ melanoma) Seventeen of the 33 registries (52%) had taken steps to remedy this problem, using surveys and letters to private dermatologists and pathology laboratories, active casefinding at outpatient laboratories and clinics, and legislation to promote reporting from nonhospital laboratories, All 3 3 areas had laws mandating the reporting of hospi-
