the form of multiple nodules
which tend to become confluent. Excision, unless performed early, is of
little avail, and in any case should be followed up by exposure to
radium.

AFFECTIONS OF CICATRICES

A cicatrix or scar consists of closely packed bundles of white fibres
covered by epidermis; the skin glands and hair follicles are usually
absent. The size, shape, and level of the cicatrix depend upon the
conditions which preceded healing.

A healthy scar, when recently formed, has a smooth, glossy surface of a
pinkish colour, which tends to become whiter as a result of obliteration
of the blood vessels concerned in its formation.

_Weak Scars._--A scar is said to be weak when it readily breaks down as
a result of irritation or pressure. The scars resulting from severe
burns and those over amputation stumps are especially liable to break
down from trivial causes. The treatment is to excise the weak portion of
the scar and bring the edges of the gap together.

_Contracted scars_ frequently cause deformity either by displacing
parts, such as the eyelid or lip, or by fixing parts and preventing the
normal movements--for example, a scar on the flexor aspect of a joint
may prevent extension of the forearm (Fig. 63). These are treated by
dividing the scar, correcting the deformity, and filling up the gap with
epithelial grafts, or with a flap of the whole thickness of the skin.
When deformity results from _depression of a scar_, as is not uncommon
after the healing of a sinus, the treatment is to excise the scar.
Depressed scars may be raised by the injection of paraffin into the
subcutaneous tissue.

_Painful Scars._--Pain in relation to a scar is usually due to nerve
fibres being compressed or stretched in the cicatricial tissue; and in
some cases to ascending neuritis. The treatment consists in excising the
scar or in stretching or excising a portion of the nerve affected.

_Pigmented or Discoloured Scars._--The best-known examples are the blue
coloration which results from coal-dust or gunpowder, the brown scars
resulting from chronic ulcer with venous congestion of the leg, and the
variously coloured scars caused by tattooing. The only satisfactory
method of getting rid of the coloration is to excise the scar; the edges
are brought together by sutures, or the raw surface is covered with
skin-grafts according to the size of the gap.

_Hypertrophied Scars._--Scars occasionally broaden out and become
prominent,