NEVUS.
Before deciding upon the question of operative interference for the removal of these congenital capillary or venous growths, the fact must be realised that, whilst the purely cutaneous forms (exemplified in " Port Wine Mark " and mevoid moles) show little, if any, spontaneous tendency to disappear, the subcutaneous and mixed types in at least half of the cases wither away as the child gets older.
Port-wine marks, formerly treated by the method of multiple scarifica tion, are now generally dealt with by Radium emanations. When the mark or so-called stain is a small one, a button of radium should be fastened on the site with strips of adhesive plaster and ]eft on for half an hour, the number of exposures and the duration of each being determined by the effect produced. Lewis Jones finds that these marks are more resistant to the radium treatment than the more severe types of mevi because the cells entering into the affected tissue are normal cells. This method of treatment leaves little, if any, deformity, the trifling superficial scar being smooth and white. X rays have given good results, and are preferable where the mark is extensive, but after both these agents sometimes a stellate visible congeries of small vessels develops later on in some parts of the scar; these can, however, be dealt with successfully by the one-polar method of electrolysis.
High-frequency currents and the withdrawal of sparks have given good results in some cases, and the electrical methods employed in the removal of the subcutaneous nevi are recommended by Morton.
The old plan of painting with caustics, as Ethylate of Sodium, &c., is now generally abandoned, Owing to the dangers of sloughing and disfiguring scar formation; but recently Carbonic Snow has been employed with marked success, and promises to come into routine use, as its scarring is trifling when skilfully handled, not more than 3o seconds' application of a crayon shaped to the size of the mark being necessary.
The form of cutaneous nevi known as the nvoid mole, as in the case of the port-wine stain, if occurring on parts covered by the clothing, requires no treatment. When its site is the face, it may be treated by Radium,
X rays, Electrolysis or Carbonic Snow. When small, the speediest and most satisfactory treatment consists in excision with the knife, but before resorting to excision puncture with a finely pointed thermo- or electro cautery may be tried.
The treatment of subcutaneous and mixed nevi, as already mentioned, should not be decided upon without waiting till the hopes of a spontaneous disappearance have passed away. But where the site of the growth is in the vicinity of the eye, where expectancy may probably render a radical removal more difficult when the child gets older, it will be advisable to operate without delay. When the nxvus is progressing or keeping pace with the body development, delay is no longer justified.
Growths on parts of the skin covered by clothing are best treated by complete excision; the dangers of hemorrhage are but trifling except in the case of very extensive and deep nevi. The old-fashioned method of strangulation by ligatures applied below pins transfixing the base of the growth, the injection of strong iron and other corrosive fluids, alcohol, carbolic acid, &c., setons and caustics should never be resorted to, and the practice of vaccination upon the site of the nievus has been completely abandoned.
The gap left by excision can be filled up by undercutting or by skin grafts on Thiersch's plan.
Subcutaneous and mixed nmvi on the face can also be treated by the methods used for the removal of the purely cutaneous type. Many will yield to Radium, some to X rays, some to Carbonic Snow, when small.
An excision must be followed by scarring, even when Thiersch grafting is employed; it is seldom indicated. The following surgical methods may be resorted to: Though caustics and escharotics are inadmissible, owing to the deform ities which they are liable to produce, in very small and circumscribed growths a sharply pointed piece of firm wood dipped in strong Carbolic or Nitric Acid may be made to puncture a minute facial nevus with the view of obliterating the small vessels, and sometimes excellent results follow.