When an epithelioma has been in an ulcerative condition for any length of time, it is not unusual for it to become infected, and this infection may be with a simple pyogenic organism, as the staphylococcus, or with some such germ as the proteus. In the putrefactive cases the odor is often horrible. In the former case, extension may take place and death result from meningitis. The first essential in dealing with an infection is to determine the character of the offending organism and the depth of the infection. In many cases the use of antiseptic wet dressing, taking care to use but little, so that there can be no poisoning from absorption, will relieve the trouble for the time being. In other cases it may become necessary to curette and cauterize, or to attempt an even more radical operation. In still other cases the uses of the proper vaccine, preferably autogenous, will greatly aid.
In the case of hemorrhage it is sometimes difficult to decide just what course to pursue, and the decision must be made quickly. The hemorrhage can often be temporarily stopped by pressure, and sometimes permanently so, for there are usually proliferative changes in the wall of a blood vessel leading to an obliterating endarteritis, before erosion actually takes place. As a general rule, it is rather difficult to catch and tie the bleeding vessel, for frequently it is found that neither the clamps nor ligature will hold because of the diseased condition of the vessel that is doing the bleeding. In such cases it often becomes necessary to either put in a circular suture or to cut down upon the blood vessel that supplies the part and tie that. In the case of simple oozing, pressure or the cautery will usually suffice to check the condition.
When the invasion of the superficial or deep cancer becomes so great that other organs than the skin are involved, the problem of the correct treatment is always complicated. In some instances, as when the orbit is invaded, there is always danger of meningitis developing, and when the mouth is invaded the patient may starve to death. Treatment in all such cases must be according to the general lines of surgery and medicine-at least give the patient comfort, and relieve as far as possible all of the symptoms. Here each case must be decided on its own merits-no specific rules can be laid down.