Alexis Thomson

“ The amount of pigment varies: when small in amount the growth is brown, when abundant it is a deep black. The most remarkable feature is the rapidity with which the disease becomes disseminated along the lymphatics, the first evidence of which is an enlargement of the lymph glands. As the primary growth is often situated on the sole of the foot or in the matrix of the nail of the great toe, the femoral and inguinal glands become enlarged in succession, forming tumours much larger than the primary growth. ”

“ Rodent cancer is liable to be mistaken for lupus, because it affects the same parts of the face; it is equally chronic, and may partly heal. It begins later in life, however, the margin of the ulcer is more sharply defined, and often presents a "rolled" appearance. ”

“ As observed on the fingers of adults, the affection takes the form of an indolent painless swelling, the epidermis being red and glazed, or warty, and irregularly fissured. Sometimes the epidermis gives way, forming an ulcer with flabby granulations. The infection rarely spreads to the lymphatics, but we have seen inoculation tubercle of the index-finger followed by a large cold abscess on the median side of the upper arm and by a huge mass of breaking down glands in the axilla. ”

“ While boils are frequently met with in debilitated persons, and particularly in those suffering from diabetes or Bright's disease, they also occur in those who enjoy vigorous health. They seldom prove dangerous to life except in diabetic subjects, but when they occur on the face there is a risk of lymphatic and of general pyogenic infection. Boils may be differentiated from syphilitic lesions of the skin by their acute onset and progress, and by the absence of other evidence of syphilis ”

“ A cicatrix or scar consists of closely packed bundles of white fibres covered by epidermis; the skin glands and hair follicles are usually absent. The size, shape, and level of the cicatrix depend upon the conditions which preceded healing.
A healthy scar, when recently formed, has a smooth, glossy surface of a pinkish colour, which tends to become whiter as a result of obliteration of the blood vessels concerned in its formation. ”

“ The lesion consists in an overgrowth of epidermis which often presents an alveolar arrangement. Moles vary greatly in size: some are mere dots, others are as large as the palm of the hand, and occasionally a mole covers half the face. In addition to being unsightly, they bleed freely when abraded, are liable to ulcerate from friction and pressure, and occasionally become the starting-point of melanotic cancer. Rodent cancer sometimes originates in the slightly pigmented moles met with on the face. ”

“ The tuberculous infection spreads slowly up the limb by way of the lymph vessels, and as these are obliterated the skin and cellular tissues become hypertrophied, and the surface is studded over with fungating tuberculous masses of a livid blue colour. As the more severe forms of the disease may prove dangerous to life by pyogenic complications inducing gangrene of the limb, the question of amputation may have to be considered. ”

“ A large carbuncle is a grave disease, especially in a weakly person suffering from diabetes or chronic alcoholism; we have on several occasions seen diabetic coma supervene and the patient die without recovering consciousness. In the majority of cases the patient is laid aside for several months. It is most common in male adults over forty years of age, and is usually situated on the back between the shoulders. When it occurs on the face or anterior part of the neck it is especially dangerous, because of the greater risk of dissemination of the infection. ”

“ The affection is a painful one and may unfit the patient for work. In mild cases the condition may be remedied by getting rid of contributing causes and by disinfecting the skin and nail; the nail is cut evenly, and the groove between it and the skin packed with an antiseptic dusting-powder, such as boracic acid. In more severe cases it may be necessary to remove an ellipse of tissue consisting of the edge of the nail, together with the subjacent matrix and the redundant nail-fold. ”

“ Recurrent attacks of inflammation frequently occur, especially in wens of the face and scalp. Suppuration may ensue and be followed by cure of the cyst, or an offensive fungating ulcer forms which may be mistaken for epithelioma. True cancerous transformation is rare.
Wens are to be _diagnosed_ from dermoids, from fatty tumours, and from cold abscesses. Dermoids usually appear before adult life, and as they nearly always lie beneath the fascia, the skin is movable over them. A fatty tumour is movable, and is often lobulated. ”

“ In children who run about barefooted in towns, tubercle may be inoculated into wounds in the sole or about the toes, and although the local appearances may not be characteristic, the nature of the infection is revealed by its tendency to spread up the limb along the lymph vessels, giving rise to abscesses and fungating ulcers in relation to the femoral glands.
Tuberculous Lupus.#--This is an extremely chronic affection of the skin. It rarely extends to the lymph glands, and of all tuberculous lesions is the least dangerous to life. ”

“ Rodent Cancer# (Rodent Ulcer) .--This is a cancer originating in the sweat glands or sebaceous follicles, or in the foetal residues of cutaneous glands. The cells are small and closely packed together in alveoli or in reticulated columns; cell nests are rare. It is remarkably constant in its seat of origin, being nearly always located on the lateral aspect of the nose or in the vicinity of the lower eyelid (Fig. 102) . It is rare on the trunk or limbs. It commences as a small flattened nodule in the skin, the epidermis over it being stretched and shining. ”

“ In more severe cases the burning and itching are attended with pain, and the skin becomes of a violet or wine-red colour. There is a third degree, closely approaching frost-bite, in which the skin tends to blister and give way, leaving an indolent raw surface popularly known as a "broken chilblain." ”

“ A sebaceous cyst may remain indefinitely without change, or may slowly increase in size, the skin over it becoming stretched and closely adherent to the cyst wall as a result of friction and pressure. ”

“ It occurs chiefly in males between fifteen and forty-five, who are farmers, fruit and vegetable dealers, or florists. There is usually a history of trauma of the nature of a scratch or a cut, and after a long incubation period there develop a series of small, hard, round nodules in the skin and subcutaneous tissue which, without pain or temperature, soften into cold abscesses and leave indolent ulcers or sinuses. The infection is of slow progress and follows the course of the lymphatics. ”

“ The application of radium is, so far as we know, the only means of preventing such return. The irritation associated with keloid may be relieved by the application of salicylic collodion or of salicylic and creosote plaster.
_Epithelioma_ is liable to attack scars in old people, especially those which result from burns sustained early in childhood and have never really healed. From the absence of lymphatics in scar tissue, the disease does not spread to the glands until it has invaded the tissues outside the scar ”

“ The scars resulting from severe burns and those over amputation stumps are especially liable to break down from trivial causes. The treatment is to excise the weak portion of the scar and bring the edges of the gap together. ”

“ The hard fibroma known as _keloid_ is described with the affections of scars.
Papilloma.#--The _common wart_ or verruca is an outgrowth of the surface epidermis. It may be sessile or pedunculated hard or soft. The surface may be smooth, or fissured and foliated like a cauliflower, or it may be divided up into a number of spines. Warts are met with chiefly on the hands, and are often multiple, occurring in clusters or in successive crops. Multiple warts appear to result from some contagion, the nature of which is unknown ”

“ The separation of the slough is a tedious process, and the patient may become exhausted by pain, discharge, and toxin absorption. When the slough is finally thrown off, a deep gap is left, which takes a long time to heal. ”

“ The _treatment_ of callosities on the foot consists in removing pressure by wearing properly fitting boots, and in applying a ring pad around the callosity; another method is to fit a sock of spongiopilene with a hole cut out opposite the callosity. After soaking in hot water, the overgrown horny layer is pared away, and the part painted daily with a saturated solution of salicylic acid in flexile collodion. ”

“ In children and women with delicate skin, applications of from ten to thirty seconds suffice. In persons with coarse skin an application of one minute may be necessary, and it may have to be repeated. ”

“ We have only seen them once--in a case of rodent cancer in the groin.
_Diagnosis._--Lupus is the disease most often mistaken for rodent cancer. Lupus usually begins earlier in life, it presents apple-jelly nodules, and lacks the rounded, elevated border. Syphilitic lesions progress more rapidly, and also lack the characteristic margin. The differentiation from squamous epithelioma is of considerable importance, as the latter affection spreads more rapidly, involves the lymph glands early, and is much more dangerous to life. ”

“ Those liable to chilblains should take open-air exercise, nourishing food, cod-liver oil, and tonics. Woollen stockings and gloves should be worn in cold weather, and sudden changes of temperature avoided. ”