The occasional development of secondary deposits in the skin of the abdomen has long been recognised, although their importance has not been sufficiently appreciated. They may occur in the form either of an induration of the linea alba (Catteau, Villar, Legg), or of small rounded tumours situated in the subcutaneous tissue. The former condition is detected upon palpation as a hard fixed and cord-like thickening, which extends from the ensiform cartilage to the navel and occasionally reaches thence to the pubes. When the round ligament is infiltrated by the new growth the umbilicus is usually retracted, the skin around it is adherent, and its surface is uneven, red, or excoriated; but in those cases where the median induration is due to cancerous invasion of the linea alba and of the subjacent connective tissue the navel often remains unaffected. In the former case the peritoneum usually exhibits secondary growths, and the linear thickening only extends as far as the umbilicus, but in the latter the serous membrane may be quite free from disease. In many thin but healthy persons a somewhat similar cord can be felt, owing to the abnormal size of the foetal remains which exist in the central line of the abdomen, but it never extends the entire distance from the ensiform cartilage to the symphysis pubis.
Superficial Metastases are met with in about 2.3 per cent, of all cases of gastric carcinoma. They are usually situated at or near the umbilicus, where they form small hard rounded tumours, which in the course of development tend to become adherent to the skin and occasionally ulcerate. Less frequently several discrete nodules appear in the subcutaneous tissue near the median line, or in the linea semilunaris, which consist of minute omental herniae that have become infected by the new growth. Finally, in rare instances the whole of the abdomen, chest, and back is beset with small movable subcutaneous tumours, which vary from the size of a millet-seed to that of a pea, and exhibit a rapid increase of size; even the muscles may be affected (Merklen). In one case of this kind that came under our notice more than three hundred nodules were scattered over the trunk; and in a similar instance recorded by Finlay the diagnosis of cylinder-celled cancer of the stomach was made from the microscopic appearances presented by one of the tumours after its excision.