(_Synonyms:_ Malignant Papillary Dermat.i.tis; Paget's Disease.)

What do you understand by Paget's disease of the nipple?

Paget's disease is a rare, inflammatory-looking, malignant disease of the nipple and areola in women, usually of advancing years, eventually terminating in cancerous involvement of the entire gland.

Describe the symptoms of Paget's disease.

The first symptoms, which usually last for months or years, are apparently eczematous, accompanied with more or less burning, itching and tingling. Gradually, the diseased area, which is sharply-defined, and feels like a thin layer of indurated tissue, presents a florid, intensely red, very finely-granular, raw surface, attended with a more or less copious viscid exudation. Sooner or later retraction and destruction of the nipple, followed by gradual scirrhous involvement of the whole breast, takes place.

What is the pathology of Paget's disease?

Although it was thought at one time to be a cancerous disease resulting from a continued eczematous inflammation of the parts, there is now but little doubt that it is of malignant nature from the earliest stages.

The psorosperm-like bodies found, to the presence of which the disease has by some authorities been attributed (psorospermosis), are now known to be merely changed and degenerated epithelia. The morbid changes consist of an inflammation of the papillary region of the derma, leading to [oe]dema and vacuolation of the const.i.tuent cells of the epidermis, followed by their complete destruction in places and their abnormal proliferation in others (Fordyce).

State the diagnostic features of Paget's disease.

The age of the patient; the sharp limitation; the well-defined, indurated film of infiltration; the peculiar, red, raw, granulating appearance; and, later, the retraction of the nipple; and, finally, the involvement of the deeper parts.

What is the prognosis?

If the disease is recognized early, and properly treated, a cure may be antic.i.p.ated; later the outlook is that of scirrhus of the breast.

What is the treatment of Paget's disease?

Thorough cauterization by means of caustic potash or the galvano-cautery; or, its extirpation by means of the curette or excision. After extirpation or cauterization, supplementary treatment by the _x_-ray is advisable as an additional measure of precaution against relapse.

Until the diagnosis is thoroughly established, soothing applications, such as are employed in acute eczema, are to be advised.

Sarcoma.

(_Synonyms:_ Sarcoma Cutis; Sarcoma of the Skin.)

Describe the several varieties of sarcoma.

Sarcoma of the skin is a more or less malignant new growth, of rapid or slow progress, characterized by the appearance of single or multiple, variously-shaped, discrete, non-pigmented or pigmented tubercles or tumors, of size varying from that of a shot to a hazelnut or larger. As a rule the growths are smooth, firm and elastic, somewhat painful upon pressure, and exhibit a tendency to ulcerate. The overlying skin is at first normal and somewhat movable, but as the growths approach the surface it becomes reddened and adherent; or, if the disease is of the pigmented variety, it acquires a bluish-black color. It is now generally believed that the most of the pigmented cases formerly thought to be of sarcomatous nature are really carcinomatous in character.

The multiple pigmented sarcoma (_melano-sarcoma_) appears first, usually on the soles and dorsal surfaces of the feet, and later on the hands.

There is more or less diffuse thickening of the integument. The lesions themselves manifest a disposition to bleed.

State the prognosis and treatment of sarcoma.

The disease is always more or less malignant and, as a rule, sooner or later a fatal termination takes place. It is usually slow in its course.

Excision or extirpation, _x_-ray exposures, and the administration of a.r.s.enic in increasing dosage (preferably by hypodermic injection) now are generally considered the most promising in this usually hopeless malady.

Granuloma Fungoides.

Describe granuloma fungoides.

A rare form of disease, heretofore looked upon as sarcomatous, but now generally recognized as granuloma, and formerly described under the names _mycosis fungoides_, _inflammatory fungoid neoplasm_, and several others. It is characterized usually by symptoms of an eczematous, urticarial, and erysipelatous nature, and by the sudden or gradual appearance of pinkish or reddish, tubercular, nodular, lobulated, or furrowed tumors or flat infiltrations, which may disappear by involution or may be followed by ulceration; several or a larger number of the growths present a mushroom, papillomatous, or fungoid appearance, sometimes roughly resembling the cut part of a tomato. In most cases the tumor stage of the malady is not reached for two or more years; in exceptional instances, however, they appear in the first few months. The lesions, especially in their early stages, are, as a rule, accompanied with more or less burning and itching.

State the prognosis and treatment of granuloma fungoides.

The malady may last for several years or much longer, a fatal termination, with rare exceptions, sooner or later taking place. After the tumor stage is well established, the patient usually succ.u.mbs in from several months to one or two years.

[Ill.u.s.tration: Fig. 65. Granuloma Fungoides.]

Treatment consists of tonics, if indicated, and the administration of a.r.s.enic, preferably hypodermically, and Rontgen-ray exposures, along with the application of mild antiseptics, and operative interference when necessary or advisable.

CLa.s.s VII.--NEUROSES.

Hyperaesthesia.

What is hyperaesthesia?

By hyperaesthesia is meant increased cutaneous sensibility. It is usually more or less localized, and is met with as a symptom in functional and organic nervous diseases.

Dermatalgia.

(_Synonyms:_ Neuralgia of the Skin; Rheumatism of the Skin; Dermalgia.)

What do you understand by dermatalgia?

By dermatalgia is meant a tender or painful condition of the skin unattended by structural change. It is commonly limited to a small area, and is usually symptomatic of functional or organic nervous disease. As an idiopathic affection it is looked upon as of a rheumatic origin.

Treatment depends upon the cause.

Anaesthesia.