A retrospective study of 166 patients with metastatic melanoma of unknown primary was performed. These were selected from 3805 cases of melanoma in Memorial Sloan-Kettering Cancer Center from 1949 through 1975 (an incidence of 4.4%). There were 109 male and 57 female patients, 75 with Stage II disease and 91 with Stage III. The site of predominant involvement in Stage II patients was the axilla (47%). Five- and ten year survival rates of Stage II patients were 46% and 41%, respectively. The only factor that was shown to influence their survival was the delay (three months or more) of radical lymphadenectomy after initial histologic diagnosis. As expected, the prognosis of Stage III patients was very poor. Our study showed that patients with metastatic melanoma of unknown primary followed a similar clinical course as the Stages II and III patients with overt primary lesion. Stage II patients could expect a reasonable survival, the treatment of choice being prompt radical regional lymphadenectomy.

A series of 54 cases of embryonal rhabdomyosarcomas in adults were studied. The neoplasms were classified according to anatomic site, size, histologic pattern, age, and sex of the patients and modality of treatment. The major anatomic sites were the extremities (21 cases), genitourinary organs (13 cases) and the trunk (nine cases). The overall five-year survival rate was 21% but 79% of the patients were dead at an average time of 17 months after the primary diagnosis was made. On the other hand, 80% of the patients with Stage I1 disease (tumor size < 5 cm) survived five years. In general, patients who were treated with surgery only or surgery and radiation or chemotherapy did much better than patients treated with chemotherapy and/or radiation therapy only. When the rate of recurrences, metastasis and time of death due to spread of neoplasm was compared in cases diagnosed between 1950-1969 and 1970-1978, patients in the last nine years had fewer recurrences, less metastases and better survival than those who had their neoplasm diagnosed and treated between 1950 and 1969.Cancer 51557-565, 1983.MBRYONAL RHABDOMYOSARCOMA is generally re-E garded as a neoplasm occurring primarily during childhood, although there have been a few reports of this neoplasm in adults.'V2 The impression that anatomic presentation and response of embryonal rhabdomyosarcoma to therapy is different from that of childhood embryonal rhabdomyosarcoma prompted this study. It is hoped that consideration of clinical presentation and prognosis together with gross and histologic appearance will contribute to better understanding of these neoplasms in adults.

Seventy patients with Merkel cell carcinoma were treated at Memorial Sloan-kettering Cancer Center between 1969 and 1989. The overall estimated 5-year survival rate was 64%. Factors predictive of improved survival included head and neck site and negative lymph nodes at presentation. Local recurrence was seen in 18 patients (26%) and did not correlate with patient-, tumor-, or treatment-related variables. Nine patients with local recurrence (50%) were free of disease following aggressive reoperation. Regional nodes were involved at some point during the course of the disease in forty-six patients (66%). Regional lymph node involvement was apparent within 2 years of diagnosis in 40 (87%) of 46 patients in whom it occurred. Systemic disease was nearly uniformly preceded by the appearance of nodal metastases and was uniformly fatal regardless of subsequent therapy. This suggests an orderly "cascade" pattern of spread for this tumor, in which elective regional lymph node dissection may be justified. Our recommendations for treatment include a wide excision of the primary tumor and either elective or early therapeutic regional node dissection. The role of adjuvant radiotherapy or chemotherapy remains unproven.

Four new patients with trabecular (Merkel cell) carcinoma of the skin are described, and an additional 76 patients from the literature are reviewed. The mean age of the combined group of patients was 68; 84% were 60 years or older. Primary tumors appeared most frequently on the head and neck (44%), leg (28%), arm (16%), or buttock (9%). No primary tumor appeared on the trunk. The rate of local recurrence was 36%, regional metastatic disease, 53%; distant metastases, 28%; and death due to metastatic tumor (minimally), 25%. It appears that trabecular carcinoma of the skin is more aggressive and lethal than previously thought. The authors recommend that patients with this tumor undergo wide resection of the primary site and, in healthy patients, prophylactic regional node dissection. Both radiation therapy and chemotherapy are effective in palliating unresectable disease.

Twelve patients with subungual squamous cell carcinoma were treated at Memorial Sloan-Kettering Cancer Center during a 27-year period. To our knowledge, only 58 cases are reported in the literature. Trauma and chronic infection were predisposing factors in some of the cases, and radiation therapy was a substantive predisposing factor in our series. Disarticulation of the distal phalanx proved effective in most patients.