The evening of life is a silent witness to the many evidences of decay of the human structure and in this tragedy, the skin also plays its role. In this epoch, one sees a slow and certain waning of the power of the skin to hold its component elements within their normal boundaries and, as a result, an anarchy among its cell elements is readily fostered. This represents the essentials of the great scourge of today, cancer.
Before discussing the topic of cancer, let us ac-quaint ourselves with those conditions which may precede it. Such a list would include moles with excessive coloring matter (pigmented moles), old age changes in the skin (keratosis senilis), and the peculiar warts of old age (senile warts). Let us now study each, in turn.
Moles.Moles are common blemishes of the skin and the average person is but little concerned about them, except when they appear upon such ex-posed parts as the face and neck. In spite of the many popular lectures and the enormous amount of propaganda by the various societies for the prevention of cancer, the danger lurking in neglected moles has not dawned upon the public at large. By way of illustration, let me recite certain well-known medical facts. There is a certain form of fatal skin cancer, known as melanotic sarcoma, which always begins as a mole. Its main characteristic is an overabundance of coloring matter (pigment). When such a mole is removed early, no harm results, but when it enlarges or forms sores (ulcers), removal may still be timely, but there is some possibility of future danger. If this last opportunity goes by unheeded, cancers often spring up in various parts of the skin, in the glands and even in the interior organs, with death as the usual termination.
Other varieties are the large, raised, hairy moles, and the small hairy ones. While these are not as apt to cause trouble, they bear careful watching as to rapidity of growth, development of sores, ulcers, etc.
Old Age Changes of the Skin.As the skin ages, certain changes are observed, as a result of which it becomes more susceptible to cancer: These changes sometimes consist in the appearance of small spots with an increase of coloring matter and a greasy look and feel. In time, these spots become covered with a thin, scarcely noticeable, scaly coating which is easily rubbed off and which may be either gray or brownish gray in color. This scaliness gradually becomes firm, increasing in thickness and upon removal shows a surface which is oily or moist. This status may remain indefinitely, but in many instances, the condition under-goes further change and when the crust is removed, there is slight bleeding indicating a break in the skin. This is at first slight, but gradually a distinct sore (ulcer) is formed and as each crust is removed, a much thicker one re-forms. The aging of the skin has now developed into the first stage of cancer.
“Old age changes” may also present another picture, one which begins with slight discoloration followed by roughness or scaliness. As this condition progresses, hard, horny elevations are observed on the skin, covered by thin, adherent scales. The elevations are usually dirty yellow, blackish gray or at times quite dark in color, and vary in diameter from that of a pea to about a half inch. These may, at times, greatly resemble ordinary warts. Such elevations may remain dormant or they may ulcerate, indicating that a cancerous condition has been established.
Such changes in the skin usually appear in those past sixty, but these same conditions have been known to appear at the age of forty, or earlier. The above described changes are most apt to be seen on the face and on the backs of the hands.
Warts.For a description of the flat warts of the aged and their relation to cancer of the skin.
Cancer of the Skin.Classification.In order to grasp the full significance of cancer of the skin, it will again be necessary to mention briefly certain facts concerning the skin structure. The main component parts of the skin are the so-called epithelial cells (round, oval, flat, or conelike bodies visible only by means of the microscope), and the connective tissue (more or less wavy, threadlike fibers). Under normal conditions, each of these occupies a properly assigned place but, when cancer exists, this arrangement is upset. If the epithelial cells cause the disturbance, we are con-fronted with a type known as “epithelial cancer” and when the connective tissue is similarly affected, we have a virulent growth, technically termed “sarcoma.”
The writer will endeavor to describe as clearly as possible the two forms of cancer in which the epithelial cells are involved. One of these shows a cell disturbance, limited only to the superficial parts of the skin, a rather mild form of cancer. The other is evidenced by a disturbance which starts in or extends to the deeper parts of the skin, a much more serious form.
Description of Epithelial Cancers.Milder forms of cancer may appear on apparently healthy skin surface or may be preceded by such skin conditions as old age changes in the skin, etc. The first noticeable variations consist of either grouped elevations of a yellow, red, or pearly color or a sort of flat thickening. Sooner or later, a very shallow sore (ulcer) appears, covered by a brown, red, or yellow crust. In the course of a number of months or years, the condition advances so that distinct sores (ulcers) result. These are usually round with a distinct, hard edge, which has a pearly appearance. This pearliness is highly characteristic of this form of cancer. The bottom of the ulcer is hard, reddish, uneven, bleeds easily and pours out a slight amount of yellowish fluid. When the border and bottom of the sore (ulcer) are scratched by a sharp instrument, it will be found that the flesh is very easily removed.
This mild form of cancer is most often seen upon the face. It may remain indefinitely as a local condition, not spreading to the glands and not affecting the general health. The pain connected with this affliction is rather slight.
The rodent ulcer is a type of superficial or surface cancer, peculiar in that its main characteristic is the breaking down and not the building up of tissue. The sores (ulcers) may be so deep that the bone may become affected. This form is usually seen about the eyelids, nose, and temples.
The deep-seated cancers may either start in the same innocent fashion as the superficial, or at the very beginning, the true nature of the virulency may be established. This variety begins as a lump or growth, situated within the true skin or even deeper. It varies in size from a pea to a walnut, is reddish or purplish in color, firm and hard. After a few months, this growth breaks down, forming an ulcer which is deep, round, or irregular in shape, with edges hard and turned out, and wax-like or purplish in color. The bottom of the ulcer is uneven, reddened, and bleeds easily. Redness and thickness of the surrounding skin is a sign that the cancer is spreading.
This type of cancer is much more rapid in its spread than the superficial, for the glands near to the growth are attacked rather early. The pain is severe and shooting. Due to its spread, this form may prove most serious and, if neglected, death may occur. Deep cancers are most apt to appear upon the face, especially the lower lip, the eye-lids and the nose. This type of cancer includes a variety which usually appears at the junction of the skin with the mucous membrane. At first the growth looks like a spongy wart. Its surface may be ‘dry and covered with horny yellow scales or it may be moist and bathed by a bloody or clear fluid. In time, this growth breaks up, forming cracks and sores.
Description of the Sarcoma.The second great group of virulent growths of the skin is known as sarcoma. There are a number of varieties of sarcoma. One of the most fatal types is that form which begins with a pigmented birthmark (a birth-mark containing excessive coloring matter). At the outset, the growth is single, bluish, brownish, or blackish in color, soft or firm to the touch, and round or oval in shape. New growths develop in the course of time, appearing at first in the neigh. borbood of the original one, but later, at a dis. tance. They may remain unchanged for a considerable time or may form sores (ulcers). Finally, the internal organs are invaded by these virulent growths, death resulting.
The only variety of the sarcoma group in which these is hope of recovery is the one that appears as brownish, bluish, or purplish spots, raised or flat and of variable size. The affected skin is thick. ened and the entire part appears swollen. This form is usually seen among males between the ages of forty and sixty. The spots appear on the feet, hands or face and the eruption is often preceded by swelling and itching. The disease lasts three to five years, or longer.
Causes of Cancer.While the definite cause of cancer is still obscure, certain conditions are definitely known as favoring its occurrence. Cancer of the skin is usually seen in those past middle life. Both sexes are equally affected, excepting that cancer of the mouth is most unusual among women. The native American Indian rarely suffers from cancer, and the Negro only exceptionally. The belief held by the lay public that cancer is an inherited condition has little or nothing to support it, except certain recent experiments with mice, which appear to show that a slight liability of the body structures for cancer may be passed on from one generation to another.
Experience and research have shown that cancer is more likely to appear in areas previously the seat of such abnormalities as warts, scars, old burns, or some long-standing skin affection. Constant overexposure to sunlight, provided the skin be oversensitive to such rays, and chronic x-ray burns, also make the skin more liable to cancerous growths. Virulent growths may also occur in chimney sweeps and workers in paraffin and tar. The prolonged use of arsenic may cause warts of the palms and soles, some of which may result in cancer.
Suggestions for Prevention and Treatment.Those with a family history of cancer will do well to heed the following suggestions. All warts and birthmarks should be promptly removed, especially if the person is past middle life. All long-standing skin afflictions should receive prompt treatment, for their presence tends to weaken the skin. All forms of continuous irritations, such as may be caused by smoking short-stemmed pipes, as well as exposure to excessive sunlight, should be avoided as much as possible, and those engaged in occupations where soot and paraffin are present are advised to follow great precautions.
The treatment of cancer, of course, requires the services of a specialist.