CARCINOMA CUTIS

The forms of carcinoma cutis of particular interest to the dermatolo­
gist are epithelioma, or skin cancer, and Paget’s disease. Before taking
up their consideration, however, the several other types known as car­
cinoma lenticulare, carcinoma tuberosum, and carcinoma melanoticum,
belonging more especially to the domain of surgery, may be briefly
referred to. Lenticular carcinoma and tuberose carcinoma are examples
of scirrhus, sometimes called scirrhous, hard, or fibrous cancer, and are
usually secondary to cancer of the breast or other organs, only rarely
occurring primarily in the skin.

Carcinoma lenticulare, or lenticular carcinoma, is seen most com­
monly about the breast in women, and developing as a secondary mani­
festation in mammary scirrhus, or in the scar tissue resulting from an
operation for a previously existing mammary growth. It presents itself
as several or more whitish or pinkish papules or small nodules, which
are usually firmly imbedded in the skin, projecting but slightly above
the surface, or the greater portion of the lesions may be above the
skin level. They are at first pin-head­ to pea-sized, and may persist
about the latter size for some time, although not infrequently some of
the growths may reach the dimensions of a cherry or larger. The cov­
ering integument is pinkish to reddish in color, with usually enlarged
capillaries coursing irregularly over its surface. From their growth,

CARCINOMA CUTIS

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multiplication, and extension they become closely crowded or practically
fuse together, and form extensive, hard, thickened, nodular areas. A
considerable part or almost the entire upper part of the chest, both
anteriorly and posteriorly, and shoulders may be gradually involved.
In extreme cases the armor-like investment more or less seriously impairs
full respiratory action, and from a blocking off or obstruction of the lym­
phatics and veins considerable swelling of the arms may occur, sufficiently
marked as to compromise mobility of the parts (cancer en cuirasse).
The progress is usually steady and moderately rapid. Softening and
ulceration are, as a rule, sooner or later noted, a condition of marasmus
develops, and the patient gradually succumbs. Exceptionally there
is observed a disappearance of some of the nodules.

Carcinoma tuberosum, tuberose or nodular carcinoma, is a still
rarer variety, and which may present on any part of the body; it is
not uncommonly disseminated or generalized, but probably oftener or
predominantly on the face or extremities. It may be a primary or sec­
ondary manifestation, and is generally seen in middle or advanced age.
The lesions are, as the name signifies, larger than those of the lenticular
variety. They begin as small nodules, somewhat deeply seated, either
in the lower part of the corium or in the subcutaneous tissue, and grad­
ually enlarge and project above the surface, the overlying skin assuming
a distended, shiny, tense appearance, and of a red color, usually with a
brownish, bluish, or purplish tinge. They are of various sizes, some­
times reaching the dimensions of an egg or larger, and in some parts
frequently being so crowded as to form large nodular masses. There
may, likewise, be an invasion of the internal organs. Sooner or later
ulceration ensues and the patient drifts more or less rapidly into a cachec­
tic or marasmic condition and succumbs. The malady may present
somewhat slowly and run a somewhat tardy course, or it may reach a
rapid and extreme development in several months.

Melanotic or pigmented carcinoma, while rare, is not so infrequent
as previously thought, inasmuch as some cases heretofore looked upon as
examples of pigmented sarcoma, starting from pigmented nævi, are now
believed to belong among the carcinomata. It would, however, be im­
possible clinically to differentiate the cases of the pigmented sarcomata
from those of pigmented carcinoma,¹ a histologic examination of the
morbid tissue being necessary for a positive conclusion. Pigmented
carcinoma generally starts from a congenital and acquired pigmented
nævus. There may be presented but one variously sized growth,
although this is exceptional; more commonly there are several, and they
may be quite numerous. Usually there is primarily a single growth, with
the development of secondary nodules near by. They may appear on
any part of the surface, the extremities and genitalia being favorite re­
gions. The tumors vary in size from a small pea to considerable dimen­
sions, and may be rounded, flattened, or fungoidal in character. In
some instances or in some regions the lesions, small in size, are crowded

¹ See Ravogli’s paper, “Multiple Nodular Melanocarcinoma of the Skin from a
Nævus,” Jour. Cutan. Dis., June, 1901 (with histologic cuts, review, and bibliography).
References to the contributions of Gilchrist and others will be found under sarcoma.

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NEW GROWTHS

together and form verruca-like patches or infiltrations. In color they
are of various dark shades, from a slate color to a purplish and bluish-
black. The larger growths, especially those having a fungoidal aspect,
tend to break down rapidly. The malady is, as a rule, extremely rapid
in its course, often involving the visceral organs early, a fatal ending
sometimes resulting in the course of some months or a year or so.

The treatment of these various forms consists in early excision.
If advanced, and operative measures are inadvisable, the continued
administration of arsenic, in increasing dosage, either by the mouth or
hypodermically, should be tried; in such instances, too, the possible fav­
orable influence of x-ray treatment should be considered.

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