A study of these few figures should clearly show that prickle-celled cancer of the skin is comparable to cancer of the breast, tongue or lips, and, just as no good surgeon would think of treating a true cancer of these organs by local removal alone, so should he shrink from the mere local removal of an analogous condition of the cutis. In many instances it is impossible to determine the exact nature of a cutaneous cancer. Here the correct procedure is undoubtedly to excise the entire growth and then make a study of it. To attempt to cure a malignant neoplasm of the limbs without first ascertaining its nature is both foolhardy and dangerous, to say the least, and will undoubtedly result in the sacrifice of many lives.

There were four cases of cuboidal-celled cancer, one of which originated from a varicose ulcer of the leg and was cured by the cautery. One developed on the scar of a bed sore on the thigh and was cured by local excision. Another originated in a senile keratosis on the thigh and recurred in the inguinal glands seventeen months after local excision. The last occurred in the scar of a trauma on the thigh, and promptly recurred in the inguinal glands after local excision. All growths were of less than one year's duration. All were in women. It is plainly evident that cuboidal-celled cancer is analogous to spino-celled cancer in the way that it metastasizes, and that it should be treated accordingly.

There were five cases of malignant warts-three on the back of the hand, one on the wrist, and one on the forearm. All originated in warty growths. Bloodgood (see page 212), in a careful study of malignant warts, comes to the conclusion that they never metastasize and that complete local removal is sufficient to effect a cure. Yet in one case in this series metastasis and death did follow a local operation, probably not a complete one. Inasmuch as these growths are more common on the back of the hand than elsewhere, inasmuch as they show a spino-celled structure, and inasmuch as they very rarely metastasize, it is probable that those who have stated that cancer of the hand is a benign affection have had most of their experience with this variety of tumor.

There were ten basal-celled cancers, which arose from the following dermatoses:

Ulcer .................................................. 6

Scar or burn........................................... 1

Pigmented mole ........................................ 1

"Pimple" ............................................. 1

Nodule ................................................ 1

They arose in the following areas:

Finger................................................. 1

Hand .................................................. 1

Upper arm............................................. 2

Ankle ................................................. 1

Lower leg ............................................. 4

Thigh ................................................. 1

In one remarkable case the glands later developed metastatic growths that showed all of the peculiarities of a spino-celled carcinoma. So far as known, there were no other metastases in this group.

In two instances there were multiple melanotic growths, secondary to pigmented moles. One occurred on the arm of a woman who had suffered but a single trauma to a pigmented mole. This immediately ulcerated and was excised, but promptly recurred. During the next five years there were a number of local operations. She then entered the hospital with a mass of inoperable glands in the axilla, but with no signs of metastatic growths in the body. It is more than probable that a complete early operation, including the axillary glands, would have resulted in permanent cure. The other instance occurred in a negro man, this being probably the only case on record of a malignant mole in one of his race. The primary growth was in the sole of the foot. There were metastases both to the glands and to the lungs, and death speedily ensued.

Penis.39-Cancer of the penis is not especially common, although certain authors state that it constitutes nearly 1 percent of all cancers, undoubtedly entirely too high an estimate.

None of the text-books or articles that the author has read has given a correct account of the pathology of these cancers, which are analogous to those occurring upon the lip. In other words, there are three varieties-first, the common prickle-celled variety; second, the prickle-celled malignant warts; and third, the basal-celled growths. Cuboidal-celled tumors also occur very exceptionally, thus really making four varieties.

The common malignant tumors are the squamous-celled ones, that usually originate on the glans penis or mucous membrane of the foreskin, and that speedily ulcerate and fungate. Metastases to the inguinal glands are nearly always present after a short time, and hence in dealing with these growths it is necessary not only to remove the local growth, but also to do a complete dissection of the glands on both sides. This should be done as upon the lip, making a block dissection, first removing the glands and then amputating the penis. Where this is not done, there are practically no recoveries, but, where this operation is performed in early cases, the percentage of cure is above 36 percent.

The prickle-celled malignant warts may be mistaken for venereal warts, but speedily ulcerate. There is, however, no induration about the base, and an extensive local removal will result in a permanent cure. In many of these cases it is necessary to amputate the end of the penis, but this is not always necessary.

*Barney: Annals of Surg., 1907, xlvi. 890. 244.

The basal-celled tumors resemble other members of this group, sometimes acting as do the slowly growing rodent ulcers, and sometimes forming fungating masses, which have a much smoother surface than the squamous-celled neoplasms. Local removal will suffice to effect a cure.