This title properly includes epithelioma and Paget’s disease which are of special interest to the dermatologist and will be considered separately, but it is necessary to consider several other types which usually belong to the domain of surgery. These are lenticular carcinoma, tuberose carcinoma and pigmented carcinoma.
Lenticular carcinoma usually occurs over a carcinomatous female breast, either before or after amputation of the primary tumor. It presents several whitish or pinkish papules or nodules firmly imbedded in the skin with pronounced or slight elevation. At first of pin-head- to pea-size, they may reach the diameter of two inches or more and by extension, growth, multiplication or coalescence form extensive, hard, nodular areas. The covering skin is red or pink in color, hard in texture, with enlarged capillaries scattered irregularly about. A considerable portion of the chest, anterior and posterior, may be involved to such an extent as to interfere with the respiratory action and free mobility (cancer en cuirasse). Steady progress with ultimate ulceration ending with a fatal marasmus is the rule.
Tuberose or nodular carcinoma is a rarer variety usually occurring on the face of old people but it may develop elsewhere and at an earlier age. Its nodular lesions, larger than those of the lenticular type, are scirrhous in character, pea- to egg-sized, firm, deep seated, flat or elevated and of a violet or brownish-red color. Eventually these growths ulcerate, resulting in deep destruction of tissue and the ulceration may reach a remarkable size, presenting an indurated and elevated margin as in epithelioma. The condition may run a rapid or slow course but eventually cachexia and metastasis to internal organs will cause a fatal ending.
Fig. 172 – Tuberose or nodular carcinoma.
Fig. 173 – Epithelioma, rodent ulcer type.
Pigmented or melanotic carcinoma is a form of pigmented tumor that is not as rare as was formerly thought and usually develops from moles or nevi. They were formerly considered sarcomatous. They may be flattened, fungoidal or wart-like. This variety runs an extremely rapid course and internal involvement soon causes a fatal ending.
Etiology and Pathology – These will be discussed more in detail under epithelioma. Sufficient to say that the causes are as yet unknown and that carcinoma cutis is epitheliomatous.
Diagnosis of carcinoma cutis rests on its possible existence elsewhere in the body and a knowledge of the evolution of the cutaneous lesions. By a careful comparison of lesions and symptoms it can be distinguished from other growths, especially from the tubercles of lupus, syphilis or leprosy.
Prognosis and Treatment – The former is bad but the advance of the disease may be held in check for a comparatively long period by the proper treatment. Operative measures are indicated when possible, but if unadvisable, the X-rays or fulguration can be persistently and carefully applied, thus arresting the progress of the disease and relieving the local pain. The hypodermic use of arsenic should be tried and the following remedies have been known to arrest or mitigate the symptoms in some cases: Arsen., Carbo. veg., Chelid., Condurango, Euphor., Hydras., Kali phos., Kreosotum and Phytolacca.