The comments of Gracely are meaningful and yet intricate. He is correct in stating that 6 of the 12 patients with lymphoma and melanoma had the diagnosis of the lymphoma before the diagnosis of the melanoma, and 6 had the diagnosis of the lymphoma after the diagnosis of the melanoma. This was clearly stated in our article.1 It was for that reason that we performed a time-consuming and tedious calculation for each of the expected incidences of malignant diseases based on age and sex, using the National Cancer Institute data recorded according to age and sex.
It was based on these calculations that we found that the diagnoses of lymphoma in 12 of the patients with the diagnosis of melanoma were equivalent to 548 cases to be expected in a population of 100 000 patients with melanoma compared with 34 cases expected among a population of 100
Ariyan S. The Association Between Melanoma, Lymphoma, and Other Primary Neoplasms-Reply. Arch Surg. 1997;132(3):320. doi:10.1001/archsurg.1997.01430270106024