The diagnosis of epithelioma, when actually existing is surrounded with very few difficulties as the induration of the tissues is hardly to be met with in any other chronic cutaneous lesion; but the physician should be prepared as well to recognize conditions which will probably become epitheliomatous in time. It is this failure to diagnosticate an impending epithelioma that leads more frequently than it should be inefficient treatment and the sacrifice of lives that might otherwise have been saved. The face is the most frequent seat of purely cutaneous epitheliomata; and if a physician can not make up his mind as to whether a certain hard tubercle or a chronic ulceration is cancerous or not, his plain duty is to take his patient to some one who can.
The prognosis of cutaneous epithelioma is good, provided the lesion is seen in its early stages, and its locality permits of suitable and efficient local treatment. On the other hand, it is distinctly bad if the disease has gained much headway or involves an extensive surface.
The treatment of epithelioma will depend firstly on whether the particular lesion in question is or is not in a curable condition. This is in reality the most serious question that the surgeon has to determine, and to its solution he should being his best judgment, based on his knowledge and experience. If he decides that it is incurable, any operation would be a barbarity, and suggestive of charlantry; but if there is a good prospect for the thorough removal of the neoplasm, no time should be lost in carrying it into effect.
The removal of epitheliomata may be effected in two ways. One of the these is with the knife, and, when this is practicable, it is the best way; and there is but one rule to follow-cut widely and cut deeply. If for any reason the knife is impracticable, the diseased tissues may be destroyed by a sufficiently active chemical agent; and experience has shown that arsenic properly used is probably the most efficient means at our command. Now, there are two ways of using arsenic; one is to use it strong enough to destroy the cancer and the other is to use a weaker preparation and destroy your patient by arsenical poisoning. The stronger the arsenial preparation the greater its local action while the weaker it is the less is its topical action and the greater the probability of systemic absorption. Take anhydrous chloride of zinc and mix it with an equal of water to this add sufficient arsenic to make a moderately stiff paste. This should be applied to the diseased parts in a reasonably thick layer with a little absorbent cotton as a top dressing. To this treatment there is one objection, namely, the severe pain that the arsenic will cause which can only be mitigated by the free use of morphine. If the lesion be of moderate size, and the application thorough the falling slough will, in a week or two, reveal a healthy ulcer, which only requires a little time for complete healing.
If the case has progressed the period when a cure may reasonably be expected the prudent surgeon will seek only to mitigate the patient’s sufferings until death brings its release.
Resorin grammes 30
Vaseline, “100 applied daily, has cured some cases that were diagnosed as epithelioma. The parts were first cleansed with borax water.
Aristol has been successfully used as a topical application.
Its advantages over arsenic are its painlessness and rapidity of action.
Thuja is the principal internal remedy. Other remedies are: sepia., Arsenicum, alb (malignant form ), Condurango, Lapis alba Nitric acid.: A roundish ulcer bluish-red and nodulated; bleeds upon slightest touch; burning pain which becomes almost unbearable, when eating or drinking when touched by cold or warm food.
Hoang nan.- Attacking especially the mucous surfaces.
Petroleum.- Nodules on hands wrists arms, feet and legs worse about wrists or wherever the dress is tight (palms and soles being free) less on face neck and parts to which oily matters find access. Pimples itching on angle between scrotum and thigh scabs in fold of left wing of nose.
Sarcoma
The word literally means a fleshy tumor and embraces in its scope a varity of new growths which present certain common features but which differ however, among and constitution.
In general it may be stated that a sarcoma is a tumor composed in the main, of cellular tissues, the cells themselves being either round or fusiform, and partaking of the characters of embryonic rather than fully organized adult tissues. The new growth is usually exceedingly vascular being permeated with large vessels, some of which are doubtless extensions from pre- existing vessels of the neighboring parts, while others are doubtless first and independently formed in the new growth itself and connect themselves later with the older vessels. In some instances there is a considerable deposit of pigmentary particles probably derived from the blood coloring matter throughout the growth. These histological changes give rise to three types of tumor-namely, the round-cell sarcoma, in which the round cells greatly predominate over the fusiform the spindle-cell sarcoma, in which these cells make up the greater part of the growth; and, thirdly, the melano or pigment sarcoma, which may resemble either of the addition of the foregoing with the addition of the pigmentary deposit. As a rule neither of these types is met within its purity, the majority of sarcomata being of a mixed type with one or the other greatly predominating.
The earliest noticeable lesion of sarcoma may be a macule or a tubercle. the macule may develop into a tubercle, or, on the other hand, may spread laterally in the skin, forming a patch or blotch one, two, or more inches in diameter. These patches are heightened in color the hue being a bluish-brown, are heightened in elevated and differ in consistence but little from the surrounding integument. In fact, they appear to be patches of chronic congestion rather than infiltration. The evolution of the macules is tardy and a year or more may be occupied before they attain any considerable size. It is possible that these macules may exist singly, but they are usually multiple. These macules may undergo complete resolution, and leave little trace of their previous existence. Under these circumstances the propriety of classing them as a variety or lesion of sarcoma might be seriously questioned were it not for the fact that they not infrequently become the starting-point of typical sarcomatous growths. After the macule has attained a certain size an elevation at one point occurs developing into a tubercle and ultimately into a tumor.
The primary tubercle of sarcoma may develop at the site of some long-standing innocent growth, as a mole, etc., or may take its origin in apparently normal skin. The former is the more usual course in persons advanced in year while the latter is commonly the case in children and young persons.
The progress of sarcoma is usually rapid, and a tubercle in a few weeks may deserve the title of tumor, and after the lapse of some months may attain the size of a child’s head or even larger.
The sarcomatous tubercles and tumors present one character which is in striking contrast with carcinomatous growth. I allude to their consistency. Sarcomata are soft sometimes of almost jelly-like consistence, while carcinomata are hard.
After sarcomata have attained a certain size, they usually soften in the more central and older portions, and break down, forming a fungoid ulcer from the base and edges of which secondary sarcomata may spring. Occasionally the margin of the ulcer becomes epitheliomatous.
No age is exempt from the development of sarcoma, but it is decidedly more frequent before the age of fifteen and after forty five than during the intermediate period. When we compare the three most important tumor types namely carcinoma, fibroma, and sarcoma we are struck with their peculiarities and contrasts. Carcinoma is especially prone to occur late in life it is a malignant growth, composed of tissue elements which are little viable and do not form permanent tissue but ultimately break down with ulceration. Fibroma, on the other hand, prefers the middle period of life, is benign, and is composed of viable and permanent tissue; while sarcoma, as we have seen prefers the extremes of life and is malignant, its elements not going to the formation of permanent tissue.
Sarcoma may be characterized by a development of either single or multiple tumors. When single and not interfered with they may attain considerable size. When multiple the tumors vary in size from that of a pea to that of hen’s egg.
Hemorrhages accompany advanced cancerous disease, but they are insignificant compared with those which may occur in sarcoma. The extreme vascularity of the new growth and the unsubstantial character of the vessel’s walls are sufficient to account for this pronounced hemorrhagic feature which not only in old and advanced tumors but even in those that are small and have had but a few weeks’ growth.
