Lupus vulgaris of many years' duration is not infrequently complicated by cancer. Sequeira* has recently published an excellent article on the prevalence of malignant change in lupus, and has reported a number of very interesting cases. He concludes that the cancerous degeneration develops only in long standing cases, and usually in persons about the prime of life. It is usually stated that about 2 percent of all cases of lupus become cancerous. Contrary to the statement of most observers, Sequeira believes that this change is more common in men than in women. The change takes place more frequently upon the face than elsewhere (Fig. 8). It is still questionable whether x-ray treatment of the lupus has been responsible for the malignant change, but apparently cancer is no more common in the cases treated by the x-ray than in the cases treated by some of the older methods. At the same time it must be remembered that it is only within a comparatively few years that the ray has been persistently used in lupus, so the future may hold many such cases in store for us. The tumors are almost invariably of the prickle-cell type, and spread rapidly and frequently metastasize. Radical operation is indicated in all cases. Local removal and radiation of the base of the ulcer is not sufficient; it may cure a few cases, but cannot give good results when tested on many patients.

*Sequeira: Brit. Jour. Dermat., 1908, xx, 40.

lupus vulgaris

Fig. 8.-This woman had suffered from lupus vulgaris for years. A deep spino-celled cancer has developed and is invading her orbit. (Heidingsfeld's collection).