HERPES LABIALIS (FEVER-BLISTER).
See HERPES FACIALIS, vol. iii.
Tumors of the Lips.
Of all primary neoplasms, about 3 per cent. originate in the lips; but these structures. show a higher percentage when cancer is alone considered: i.e., about 5 per cent. As compared to other forms of tumor observed in this region, —papilloma, sarcoma, angioma, fibroma, and cystoma,—cancer is observed in 99 per cent.
This variety of growth ahnost ex clusively develops in the lower lip. Of 352, cases analyzed by W. R. 'Williams (Brit. Med. Jour., Apr. 11, '92), 340 originated from the lower lip. Of 1193 instances recently studied by Fricke (Deut. Zeit. f. Chir.; Ther. Gaz., May 15, '99), the upper lip was affected in but 63 instances. The predilection of this situation for the development of cancer as regards sexes is as striking. In the series of cases just mentioned 94 per cent. occurred in males. It is essen tially a disease of adult and advanced life, the average being about 60 years; but carcinoma has been observed long before the fortieth year: the limit usually accepted. Fricke's list ranged from 24 to 83 years. A large proportion of the cases were in laborers and farmers, and heredity seemed to play a minor role. Pipe-smoking appeared to be an important predisposing factor, wounds and abrasions coming next in order.
Symptoms.—A cancer may be gin as a mere excoriation, fissure, or ulcer, that will not heal; a small tubercle covered by a thick scab that recurs as soon as picked off; or as a warty growth. The ulceration gradually spreads and deepens, the surrounding tissues being infiltrated and hard. In many cases the carcinoma begins as an ulcerating in duration. The ulcer gradually assumes the typical appearance of an epitheliom atous growth, with an irregular slough ing base and abrupt everted edges. When irritated by the injudicious use of caustics or "specifics," it tends to fun gate ancl its growth becomes more rapid. At this stage it usually becomes quite painful, and nutrition soon suffers through the inability of the patient to take sufficient food, and a state of ma rasmus soon becomes evident, owing to repeated luemorrhages, the ingestion of cancerous detrilvs, etc. General tox
annia is by this tiine fully demonstrated by the patient's facies, and lie sinks with increasing rapidity until death relieves him of his suffering. As a rule, the development is very gradual, and the glands of the jaws are not involved early. -Enlargement of these glands and even their induration does not neces sarily imply carcinomatous infiltration. Glands examined immediately after re moval liave been found free of malig nant degeneration (Fricke); but there is no doubt that such glands constitute foci for carcinomatous changes and that they should be removed whenever pos sible.
Diagnosis.—Chancre of the lip some times renders the diagnosis somewhat Carcinoma_, as we have seen, occurs almost always in men: chancre is more frequently observed in women than in men, and may occur at any agc, while cancer seldom occurs before, the fortieth year. The progress of cancer is slow and the involvement of lym phatic glands is tardy: chancre advances rapidly, lasts but a few weeks, and the glands are SOOVI illVOIVed. Filially the secondary maul resin ti ons appear in syphilis and greatly improve under spe cific treatment. Caneer progresses re gardless of all internal remedies.
Prognosis. — l'r el,e's statistics op . rtsulted as follows: • r t. au immediate result :;•.? sutttred from .. --, • pt r tt nt. were pernia .. 'Flit prognosis of labial rt fore good if operation is : • ' ei i.e. however. the I par.•tid glands are involved • ii,rtrous process. The prognosis • rahle when the infiltration •, r tile jaw or has extended to _i• • •,•••., orzans.
\ . r (ollected from 1S43 to 1SS4, • La,e,.. of labial cancer which had 1 1, rated. Of these 2S.1 per cent.
• 1—rinanently. MaIweg in his t• eLllectid Is•2 operated at the Bonn fr..11 B-ti6 to ISS7. Of these 57 r.,tirrcd aiel died: 44 recovered, but had lest yet completed the third year a fur the oi eration ; 32 have passed the third year !ince the operation without rt-uralice: 49 have already completed tte sixth year ,ince the operation and i.are not relapsed. Forgue (Gaz. des Mar. 25, '9u..