I  believe  that  it  wUl  be  useful  to  describe  separately  the  external
characters  of  the  two  principal  varieties  of  epithelial  cancer  of  the  in-
teguments here  indicated  ;  and  (while  remembering  that  mingled, transi-
tional, and  intermediate  specimens  may  be  very  often  seen),  to  speak  of
them  as  the  superficial  or  outgrowing,  and  the  deep-seated,  forms  of  the
disease.'

Among  the  examples  of  the  superficial  epithelial  cancers,  the  greater
part  derive  a  peculiar  character  from  the  share  which  the  papillae  of  the
skin  or  mucous  inembrane  take  in  the  disease.  These  being  enlarged,
and  variously  deformed  and  clustered,  give  a  condylomatous  appearance
to  the  morbid  structures,  which  has  led  to  their  being  called  papillary  or
warty  cancers,  and  which  renders  it  sometimes  difiBcult  to  distinguish
them  from  common  warty  growths.  According  to  the  changes  in  the
papillaB,  numerous  varieties  of  external  appearance  may  be  presented :
I  shall  here  describe  only  the  chief  of  them."

In  the  most  ordinary  examples  of  epithelial  cancer  of  the  lower  lip,
or  of  a  labium,  or  of  the  scrotum  in  the  soot-cancers,  if  they  be  exam-
ined previous  to  ulceration,  one  can  feel  an  outspread  swelling,  and  an
unnatural  firmness  or  hardness  of  the  affected  skin.  The  width  and
length  of  the  swelliug  are  much  greater  than  its  thickness.  The
diseased  part  is  enlarged ;  the  Hp,  for  example,  pouts,  and  projects  like
one  overgrown  ;  and  the  swelling  is  slightly  elevated,  rising  gradually
or  abruptly  from  its  borders,  and  having  a  round  or  oval  or  sinuous
outline.     Its  surface,  previous  to  ulceration,  may  be  nearly  smooth,  but

•  I  believe  that  either  of  these  forms  may  occur  in  any  of  the  parts  enumerated  as
the  usual  seats  of  epithelial  cancer  ;  hut  they  are  not  both  equally  common  in  every
such  part.  The  superficial,  and  especially  those  which  have  the  chaiacters  of  warty
and  cauliflower-lite  outgrowths,  are  most  frequently  found  on  mucous  surfaces,  espe-
cially those  of  the  genital  organs ;  the  deep-seated  are  more  frequent  in  the  tongue
than  elsewhere ;  those  in  the  extremities  and  in  the  scrotum  have  usually  a  well-
marked  warty  character,  and  are  rarely  deep  seated.  Other  particulars  might,  I
believe,  be  stated,  but  I  am  unwilling  to  state  them  unsupported  bv  counted  numbers
of  cases.
