ariety of epithelioma.#

The papillomatous type usually arises from the superficial or
deep-seated variety, or it may begin as a papillary or warty growth.
When fully developed, it presents an ulcerated, fissured and
papillomatous surface, with an ichorous discharge which dries to crusts.
It is slowly progressive, and sooner or later may develop a malignant
tendency.

#Upon what parts is epithelioma commonly observed?#

About the face, especially the nose, eyelids and lips; and also about
the genitalia. It may involve any part.

#At what age is epithelioma usually noted?#

It is essentially a disease of middle and late life, although it is
exceptionally met with in the young.

#What is the cause of epithelioma?#

The etiology is obscure. It is not, as a rule, inherited. Any locally
irritated tissue may be the starting point of the disease.

#State the pathology.#

The process consists in the proliferation of epithelial cells from the
mucous layer; the cell-growth takes place downward, in the form of
finger-like prolongations or columns, or it may spread out laterally, so
as to form rounded masses, the centres of which usually undergo horny
transformation, resulting in the formation of onion-like bodies, the
so-called cell-nests or globes. The rapid cell-growth requires increased
nutriment, and hence the bloodvessels become enlarged; moreover, the
pressure of the cell-masses gives rise to irritation and inflammation,
with corresponding serous and round-cell infiltration.

#How would you distinguish epithelioma from syphilitic ulceration, wart,
and lupus vulgaris?#

From syphilis it is to be differentiated by the history, duration,
character of the base and edges, its comparative slow progress, its
usually slight, viscid discharge, often streaked with blood, and, if
necessary, by the therapeutic test.

Wart or warty growths are to be differentiated by attention to their
history and course. Long-continued observation may be necessary before a
positive opinion is warrantable. The appearance of any tendency to
crusting, to break down or ulcerate is significant of epitheliomatous
degeneration.

In lupus vulgaris the deposits are peculiar and multiple, the
ulcerations are of different character, the tendency to scar-formation
constant; and, with few exceptions, it has, moreover, its beginning in
childhood or early adult life.

#What factors are to be considered in giving a prognosis in epithelioma