Psoriasis--verruca--epithelioma : a sequence / by James C. White.

  • James Clarke White
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Psoriasis--verruca--epithelioma : a sequence / by James C. White. Source: Wellcome Collection.

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    involved in the perverted development only after prolonged efforts to reproduce themselves in proper place and form. It is, however, in the course of affections of the epithelial structures of the skin that this malig¬ nant transformation is most frequently observed. The most common starting point of epithelioma of the face in all its clinical varieties from the flat, superficial forms to the “ rodent ulcer,” or stages of deep pene¬ tration, is that very frequent condition of imperfect epidermal formation after middle life called keratosis senilis. The cutaneous horn, the seba¬ ceous cyst, both modifications of the epithelial structures, may eventually, as is well known, undergo transformation into this disease, and, to approach more closely to the anatomical conditions in this case, the pointed condy¬ loma and the ordinary verruca, essentially identical in structure and primarily an epidermidosis rather than a papilloma, may also terminate in it. Epithelioma of the skin may be said not only to follow all these affections above described, but to rarely occur without some similar precedent process. In this instance two factors may have been operative in the develop¬ ment of the final condition, not only the verrucous hypertrophy with the possibilities of epitheliomatous transformation essentially incident to it, but the prolonged ulceration and granulation of the cutaneous tissues, which may at first have been simply the expression of futile reparative efforts in a part of less vitality than the surrounding structures and ter¬ minating in a perversion of cell development. Whether one or both of these agencies were active and just when the epitheliomatous transforma¬ tion was established in this case, cannot be definitely determined. Eventually there were observed, in addition to the slowly progressive infiltration and destruction of the surrounding tissues, the development of encysted centres of secondary metamorphosis (colloid) beyond the visible bounds of the disease, and finally a most rapid outburst of exuberant fungoid outgrowth. Thus we have established an uninterrupted sequence of psoriasis through verruca into epithelioma, or, in other words, psoriasis as a cause of carci¬ noma. Of so serious a termination of so common an affection I could find no record, and believed that the case would remain in my experience, as long in the future as in the past, unique. Case II—On the first of August of this year a gentleman, fifty-two years old, consulted me on account of a sore upon his hand of several years’ duration. He showed me an ulcer occupying the anterior surface of the right wrist, extending slightly into the palm of the hand, about two inches in length and one and a half inches in transverse diameter. It was surrounded by a very prominent and indurated border, extending deeply beneath the skin, and was very painful. I noticed at the same time upon his forehead several small, slightly elevated patches, red and covered with thin scales, and upon the hands and fingers a considerable number of horny, wart-like growths. I immediately recognized that I