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Lynch syndrome (LS) is a common genetic syndrome characterized by pathogenic mutations of DNA mismatch repair genes resulting in a hereditary predisposition to cancer. While typically associated with colonic and endometrial cancer, LS additionally influences the development of many other malignancies. The Amsterdam II and Revised Bethesda Guidelines are the established clinical criteria for diagnosing LS. These guidelines are based on the most general characteristics of LS and do not address specific characteristics of the less commonly LS-associated malignancies. For individuals that present initially with a non-colon and non-endometrial malignancy, recommendations and guidelines on when to consider screening for LS are limited. Therefore, it is essential that clinicians are familiar with distinct LS-associated patient- and tumor-specific characteristics, especially of the less common LS-associated cancers, so that LS’s diagnosis is not missed. In this review article, we focus on extra-colonic and extra-endometrial LS-associated cancers, paying particular attention to any established or currently investigated cancer features that help raise suspicion for LS and potentially lead to its earlier diagnosis. This review will also discuss current guidelines specific to each LS-associated malignancy.

32 Background: The University of Tennessee Medical Center (UTMCK), Knoxville Tennessee is the region’s sole academic medical center. Annually, 3000 new patients are seen within the Cancer Institute (CI) of UTMCK, and over 13% are breast cancer patients. Under the leadership of our director, Surgical Oncologist Dr. John L. Bell, survivorship care has been offered to these patients for almost twenty years. This combination has created a unique opportunity for us to look at long term results of offering disease-specific survivorship care, and what effect it has made upon detection of recurrence. Methods: Tumor registry data was utilized to examine the influence of survivorship care upon detection of recurrence. All patients treated from 1999 – 2015 with a diagnosis of recurrent breast cancer were selected out of the tumor registry. These patients were then stratified by time to recurrence, and mean, median, and range were calculated in time to recurrence (TR) by month. Results: A total of 223 patients with recurrent breast cancer were identified in our tumor registry out of 4422 total breast cancer patients treated by UTMCK from 1999 – 2015, recurrence rate of 5.04%. The mean TR for this cohort was 43.9 months. The median TR was 33 months, and the range of TR varied from 4 months to 166 months. All patients were followed for a minimum of five years following their diagnosis, and by 60 months, 73.99% of all recurrences were identified. Conclusions: Offering disease specific survivorship care to breast cancer patients is beneficial to both patients and our institution. When recurrence is diagnosed, survivorship care is valuable by helping to identify these cases as early as possible, to get patients back into active treatment sooner in the disease process. We have demonstrated that this is not a recent phenomenon reflective of current practice changes and accreditation requirements, and have validated this with our institution’s long history of providing survivorship care services for breast cancer patients dating back to the last century.

181 Background: The University of Tennessee Medical Center in Knoxville, Tennessee is the regions only academic medical center. This includes the Cancer Institute, where in 2013 a division dedicated to melanoma and soft tissue tumors (MASTT) was created. Since 2013, the number of melanoma cases treated at UTMCK treated has increased in excess of 300%. One critical aspect of the MASTT service was to provide survivorship care to all patients treated. This has given MASTT a unique opportunity to determine how survivorship care has impacted detection of recurrence in melanoma. Methods: Tumor registry data was retrospectively reviewed from a prospectively maintained database. All melanoma patients treated from 2011 to 2015 were identified. This cohort was selected because all of these patients would have been eligible for survivorship care. These patients were then stratified into stage and sub-stage, recurrence status, stage at recurrence, and whether alive or dead. Median and range of time to recurrence were calculated as well. Results: A total of 758 patients were treated for melanoma between 2011 and 2015 at UTMCK by the MASTT service. From this overall sample, a total of 37 patients demonstrated recurrence (4.88% overall). Local recurrence was noted in 9 cases (1.2%), regional recurrence in 4 cases (0.53%) and distant in 15 cases (2.0%). Seven of the recurrent cases were not specified. Median time to recurrence was 12 months (6-40 months). Overall mortality rate for patients with recurrent melanoma was 18/37 (48.6%). Nationally, local recurrence rates are reported between 3 – 5%. Conclusions: A retrospective analysis of tumor registry data for melanoma patients treated at UTMCK CI by the MASTT service line shows that offering survivorship care to this population is beneficial in detecting recurrence. This is key in getting patients evaluated and established for immunotherapy and/or other treatment options at the earliest time of recurrence, which can potentially improve their response to treatment by.