Operative measures, such as punctate and linear scarification, electrolysis and excision, are occasionally practised, but the results are rarely satisfactory and permanent; not infrequently, indeed, renewed activity in the progress of the growth is noted to follow. The _x_-ray can be tried with some hope of improvement. The administration of thyroid has been thought to have a possible influence in some instances.

Fibroma.

(_Synonyms:_ Mollusc.u.m Fibrosum; Fibroma Mollusc.u.m.)

What do you understand by fibroma?

Fibroma is a connective-tissue new growth characterized by one or more sessile or pedunculated, pea- to egg-sized or larger, soft or firm, rounded, painless tumors, seated beneath and in the skin.

Describe the clinical appearances of fibroma.

The growth may be single, in which case it is apt to be pedunculated or pendulous, and attain considerable dimensions; as a result of weight or pressure surface-ulceration may occur. Or, as commonly met with, the lesions are numerous, scattered over large surface, and vary in size from a pea to a cherry; the overlying skin being normal, pinkish or reddish, loose, stretched, hypertrophied or atrophied.

The tumors are painless. The general health is not involved.

[Ill.u.s.tration: Fig. 41. Fibroma. (_After Octerlony._)]

What is the course of fibroma?

Chronic and persistent.

What is the etiology of fibroma?

The cause is not known. Heredity is often noted. The affection is not common.

State the pathology of fibroma.

The growths are variously thought to have their origin in the connective tissue of the corium, or in that of the walls of the hair-sac, or in the connective-tissue framework of the fatty tissue. Recent tumors are composed of gelatinous, newly-formed connective tissue, and the older growths of a dense, firmly-packed, fibrous tissue.

From what growths is fibroma to be differentiated?

From mollusc.u.m contagiosum, neuroma and lipoma; the first is differentiated by its central aperture or depression, neuroma by its painfulness, and lipoma by its lobulated character and soft feel.

Give the prognosis of fibroma.

The disease is persistent, and irresponsive to all treatment save operative measures.

What is the treatment of fibroma?

Treatment consists, when desired and practicable, in the removal of the growths by the knife, or in large and pedunculated tumors by the ligature or by the galvano-cautery.

Neuroma.

Describe neuroma.

Neuroma of the skin is an exceedingly rare disease, characterized by the formation of variously-sized, usually numerous, firm, immovable and elastic fibrous tubercles containing new nerve-elements, and accompanied by violent, paroxysmal pain. Their growth is slow and usually progressive. Later they are painful upon pressure. They are limited to one region.

The tumors are seated in the corium, extending into the deeper structure, and consist of nerve-fibres, yellow elastic tissue, blood vessels and lymphoid cells.

In the two cases reported, excision of the nerve-trunk gave, in one instance, permanent relief; in the other the effect was only temporary.

Xanthoma.

(_Synonyms:_ Vitiligoidea; Xanthelasma.)

What is xanthoma?

Xanthoma is a connective-tissue new growth characterized by the formation of yellowish, circ.u.mscribed, irregularly-shaped, variously-sized, non-indurated, flat or raised patches or tubercles.

Name the two varieties met with.

The macular or flat (_xanthoma planum_) and the tubercular (_xanthoma tuberculatum_ or _tuberosum_). In some instances both varieties (_xanthoma multiplex_) are seen in the same individual.

Describe the clinical appearances of xanthoma planum.

The macular or flat variety is usually seen about the eyelids. It consists of one, several or more small or large, smooth, opaque, sharply-defined, often slightly raised, yellowish patches, looking not unlike pieces of chamois-skin implanted in the skin.

Describe the clinical appearances of xanthoma tuberosum.

The tubercular variety is commonly met with upon the neck, trunk and extremities. It occurs as small, raised, isolated, yellowish nodules, or as patches made up of aggregations of millet-seed-sized or larger tubercles. The lesions may be few or they may exist in great numbers.

What is the course of xanthoma?

Extremely slow; after reaching a certain development the growths may remain stationary.

State the etiology of xanthoma.

The causes are obscure. Jaundice not infrequently precedes and accompanies its development, especially in the tubercular variety. The disease is uncommon, and is usually seen in middle and advanced life, and more frequently in women. In some cases (_xanthoma diabeticorum_) of general xanthoma diabetes is the causative factor.