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To the Editor.
—In the March 1983 Archives (101:487) Romano et al state: "To facilitate the early detection of such lesions [second nonocular tumors], we now plan specifically to examine all patients with a bilateral retinoblastoma for such lesions every six months and to perform a bone scan once a year." I share with them the concern and fear of these second nonocular tumors but question if their approach is the most appropriate or productive one.First, it must be emphasized that the patients who are at risk for the development of second nonocular tumors are not only the patients with bilateral retinoblastoma but allpatients with the germinal mutation. Thus I would suggest that evaluation be performed on the conditions of all unilaterally affected patients who: (1) have been found to have a constitutional chromosomal anomaly involving Q1-4 region of chromosome 13, (2) have a family history of retinoblastoma,