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To the Editor: The observation by Dr Kahn and colleagues¹ is important and merits further research. In 1970, we extended earlier work² establishing that the probability of metastases from colon cancers to lymph nodes was independent of the size of the colon cancer. When we compared metastasizing and nonmetastasizing variants, the most statistically significant characteristic of patients with metastasizing variants was past or present nonmelanoma skin cancer. The host's exposure to factors (ie, UV rays) severe enough to cause skin cancers appears to have a systemic effect not fully studied.

John S. Spratt, Jr, MD
University of Louisville School of Medicine
Louisville, Ky

1. Kahn HS, Tatham LM, Patel AV, Thun MJ, Heath CW Jr. Increased cancer mortality following a history of nonmelanoma skin cancer. JAMA. 1998;280:910-912. FREE FULL TEXT 2. Spratt JS Jr, Watson FR, Pratt JL. Characteristics of variants of colorectal carcinoma that do not metastasize to lymph nodes. Dis Colon Rectum. 1970;13:243-246. ISI | PUBMED

In Reply: We thank Dr Spratt for his interest in the association we observed, although in our study the age-adjusted death rate due to cancers of the colon and rectum was not higher among either men or women who reported a history of nonmelanoma skin cancer. However, . . . [Full Text of this Article]

RELATED ARTICLE

Increased Cancer Mortality Following a History of Nonmelanoma Skin Cancer
Henry S. Kahn, Lilith M. Tatham, Alpa V. Patel, Michael J. Thun, and Clark W. Heath, Jr
JAMA. 1998;280(10):910-912.
ABSTRACT | FULL TEXT