The spinocellular cancer of the lip commonly starts at the mucocutaneous border, and the first symptom is an area of induration, with slight ulceration. Both the induration and the ulceration tend to increase rapidly, and the submaxillary lymph glands soon become hard and shot-like. This growth often has the appearance of chancre, and the following are the chief diagnostic points. Chancre is common in the young; cancer is common in the old and rare in the young; cancer is very rare in women; chancre equally common in the two sexes; chancre is almost as common upon the upper lip as upon the lower, which is not true of cancer; in chancre the growth is much more rapid than in cancer, and the lymph glands enlarge much earlier; the spirochete can be demonstrated in chancre, and the histological picture of the two is radically different. A dose of salvarsan will cause the speedy disappearance of a chancre. It must always be remembered that a chancre will not give a positive Wassermann reaction-at least not until late in its course.

Fungating carcinoma of the lower Hp

Fig. 79.-Fungating carcinoma of the lower lip. of only five weeks' duration. . (C. J. White's collection).