The Head and Neck 39 



Treatment. Hematomata should not be interfered with but 

 allowed to undergo absorption. 



Cutaneous Horns. There are a few cases of this peculiar form 

 of growth on record. Favorite positions are the forehead and inner 

 surface of the ear. The manner of their formation from sebaceous 

 cysts and papillomata is described in the chapter on Neoplasms. 



Symptoms and Diagnosis. As the name indicates, they are 

 circumscribed outgrowths much resembling a horn. 



Treatment. Extirpation should be practised, but the cyst at the 

 base of the horn must be removed at the same time. 



Sarcoma. Sarcoma of periosteal origin occasionally arises in 

 the forehead. Being of highly malignant character with a great 

 tendency to invasion of adjacent parts, the prognosis must always 

 be grave. Sarcoma of cuticular or subcuticular origin is occasion- 

 ally seen but it is not common. It has been observed to follow 

 scratches or wounds. 



Symptoms and Diagnosis. Periosteal sarcoma occurs as a sub- 

 cutaneous enlargement or upheaval which exhibits a very rapid 

 growth and soon attains an enormous size. The consistence of the 

 growth is variable. Usually it is bone-hard at its base, but may fluc- 

 tuate in the center of its surface. If adjacent bones are involved 

 when the tumor has its seat in the forehead, there may be a hemorr- 

 hagic discharge from the nasal passages. Sarcoma of the skin ap- 

 pears as an irregular tuberculate growth and assumes a fungoid 

 character when it breaks through the dermis. 



Treatment. An operation in the early stages offers some chance 

 of effecting complete eradication of the growth. Not only the actual 

 tumor but the healthy tissues in the immediate neighborhood must 

 be freely removed. 



Epithelioma. Carcinoma,. These tumors, formed of prolifer- 

 ating atypical epithelial or glandular (sebaceous or sudoriferous) 

 cells show a predilection for the head, notably the forehead and 

 vicinity of the ears, but occur also in other parts. 



Symptoms and Diagnosis. Cancerous tumors vary in size from 

 a pea to the infantile head. In consistence, they are moderately firm 

 or hard, they are intimately united with the skin, and mobile from 

 the underlying structures, have a rather circumscribed, irregular, 

 puckered surface, and exhibit a tendency to ulcerate and become 

 metastatic to the nearest lymphatic glands. 



