epithelioma_--usually of the exuberant or
cauliflower type, which, like other epitheliomas that originate in scar
tissue, presents little tendency to infect the lymphatics.

The _diagnosis_ of lupus is founded on the chronic progress and long
duration, and the central scarring with peripheral extension of the
disease. On the face it is most liable to be confused with syphilis and
with rodent cancer. The syphilitic lesion belongs to the tertiary
period, and although presenting a superficial resemblance to
tuberculosis, its progress is more rapid, so that within a few months it
may involve an area of skin as wide as would be affected by lupus in as
many years. Further, it readily yields to anti-syphilitic treatment. In
cases of tertiary syphilis in which the nose is destroyed, it will be
noticed that the bones have suffered most, while in lupus the
destruction of tissue involves chiefly the soft parts.

Rodent cancer is liable to be mistaken for lupus, because it affects the
same parts of the face; it is equally chronic, and may partly heal. It
begins later in life, however, the margin of the ulcer is more sharply
defined, and often presents a "rolled" appearance.

_Treatment._--When the disease is confined to a limited area, the most
rapid and certain cure is obtained by _excision_; larger areas are
scraped with the sharp spoon. The _ray treatment_ includes the use of
luminous, Rontgen, or radium rays, and possesses the advantage of being
comparatively painless and of being followed by the least amount of
scarring and deformity.

Encouraging results have also been obtained by the application of carbon
dioxide snow.

#Multiple subcutaneous tuberculous nodules# are met with chiefly in
children. They are indolent and painless, and rarely attract attention
until they break down and form abscesses, which are usually about the
size of a cherry, and when these burst sinuses or ulcers result. If the
overlying skin is still intact, the best treatment is excision. If the
abscess has already infected the skin, each focus should be scraped and
packed.

#Sporotrichosis# is a mycotic infection due to the sporothrix Shenkii.
It presents so many features resembling syphilis and tubercle that it is
frequently mistaken for one or other of these affections. It occurs
chiefly in males between fifteen and forty-five, who are farmers, fruit
and vegetable dealers, or florists. There is usually a history of trauma
of the nature of a scra