Epithelioma

Epithelioma, or epithelial cancer of the skin, is characterized by the appearance of a hard tubercle or nodule, slowly increasing in size until ulceration sets in, which ulceration may extend both laterally and deeply and destroy all tissues with which it comes in contact. As its name implies, it is an outgrowth from the epithelial tissues, in which a more or less extensive and exuberant proliferation of epithelial cells occurs. The typical epithelioma may be said to take its origin in the Melpighian layer, the cells of which increase in number and seek accommodation in the deeper layers of the skin. As they increase, however, some of them, from the pressure of the neighboring connective tissue, are forced to occupy a smaller space than they would if permitted to multiply freely in all directions. As a result of this compression, small rounded bodies are formed, in which the cells assume a stratified arrangement, constituting the epithelial cell-nests well-known to every microscopical observer. Coincident with this extension of the disease inward there is a greater or less projection outward, forming a distinct sessile tubercle, or a more flattened growth.


Primary cancer of the skin is a rare condition, while epithelioma, involving both cutaneous and mucous surfaces - as ordinary cancer of the lip - is sufficiently common. Cancer of the skin, however, which has developed secondarily to some pre-existing morbid growth, is the variety most frequently found in practice.Epithelioma is distinctly the product of irritation - not an acute and transient irritation, even if frequently repeated, but rather one that is hardly, if at all, appreciable to the senses, and which is persistent and active through a lengthened period. Thus we may find that a purely innocent and benign growth, like a simple wart, may, after a lapse of years, become the seat of an epithelioma, which would not otherwise have appeared. A localized seborrhoeic condition, which of itself implies an irritation of the epithelial lining of the glands, may, and not infrequently does, become the starting point of cancer. Lupus offers an inviting field for the development of the disease; and in general it may be said that an ulcerating lupus, if left to itself, will almost invariably in time become supplanted by epithelioma. Sarcoma more rarely is followed by epithelioma, and this rarity may be explained by the fact that sarcoma usually runs its course and has destroyed the patient before the cancerous affection has had time to develop - the irritation produced by the sarcoma being more active than that which ordinarily leads to the occurrence of the other disease.


Epithelioma is met with clinically in two distinct forms, in one of which the cutaneous involvement is more superficial than in the other. In the superficial variety, which is less frequently met with than the other, the patient's attention is first attracted to a little crust - usually on some part of the face. This he picks off, and gives little further attention to the matter. A new crust forms, and this in turn picked off, reveals, perhaps, a slightly excoriated surface. He consults a physician, who, failing to recognize the gravity of the condition, prescribes some salve or other, or lightly touches the part with caustic. The lesion extends, and perhaps rarely reaches the hands of a surgeon until it has advanced to the stage of frank ulceration. We now find a sharp-cut ulcer, extending through the entire thickness of the skin, but not involving the subcutaneous tissues. This ulceration advances at its borders, or sometimes in one direction only, while reparative changes may sometimes occur in the other, much after the manner of some cases of lupus. The progress of the ulceration is exceedingly tardy, and years may elapse before the ulcer has attained any considerable size, when it does, we will sometimes find that cicatrical tissue now occupies a portion of the territory that had been the early seat of the cancerous lesion.

The other, or tuberous form of epithelioma, will be recognized at the beginning as a hard tubercle, occupying the seat of what may have been previously the situation of a wart, mole, etc. This tubercle increases in size, and the tissues beneath it are palpably involved in the morbid process. The skin surrounding the tubercle is also involved to a certain, or, rather, uncertain extent, as is evident to sight and touch. Later, ulceration appears, and the margins of the ulcer are everted and hard. As the ulcer spreads laterally, so also does it become deeper, and the process continuing unchecked leads in time to a fatal termination.