PRECANCEROUS skin lesions.

Among clinical varieties of cancer, skin cancer is fully demonstrating the destructive power of the scourge. It is safe to say that cancer statistics fall far below the actual number of cases. United States Census figures of cancer mortality show 72,550 deaths for 1920. The cancer of the gastrointestinal tract is leading; the second is cancer of the female generative organs and of the breast; cancer of the skin is the last. Adding to it cancer of the lips, tongue, and buccal cavity, which properly falls in the field of dermatology, skin cancers make up about 7 per cent of the total cancer mortality. According to the United States Census figures, this would make for 1920 not less than 5000 deaths from skin cancer in this country. Skin Cancer vs. Systemic-Skin cancer deserves earnest study and attention at the hands of physicians for two special reasons. To appreciate these reasons one has only to consider the peculiar topographic location of the skin in the human economy and resulting therefrom peculiarities in skin diagnosis and pathology. Skin is the only surface organ of the body, subject to a direct and complete inspection. Skin' offers a unique opportunity of a direct objective diagnosis unequaled by any other organ. It offers a unique opportunity of the earliest possible diagnosis of cancer, in the so-called precancerous stage, before the actual malignancy has set in. How simple is clinical diagnosis of skin cancer, even in its earliest incipiency, in comparison with cancer of the visceral organs. A positive or at least suggestive diagnosis can be obtained through mere inspection, palpation, and careful clinical study of the lesion and of the adjacent tissues. Yet how many cases of skin cancer come for treatment in a very advanced stage! Not all of these cases are due to ignorance or neglect of the patients themselves or of their quasi-medical advisers. A certain amount of responsibility must be laid at the door of the medical profession, both because of insufficient familiarity with clinical features of early skin malignancy, and because of a certain lack of energy in looking for and detecting these lesions. A thorough and detailed familiarity with clinical characteristics of precancerous lesions is imperative in the prevention of cancer. As precancerous skin lesions ordinarily produce no subjective distress or annoyance, physicians should be all the more careful in scrutinizing skin lesions. Therapeutic Aspects of Skin Cancer-The same anatomic peculiarities of the skin which make for unique diagnostic opportunities offer also unique therapeutic advantages in cancer problem.' Skin cancer is, unquestionably, the least dangerous clinical form of cancer and gives the best prognosis for these very reasons. It can be diagnosed earlier than any visceral variety, and it can be extirpated and destroyed without injury and destruction of the rest of the body. Both surgery and radiotherapy record most of their successes in the field of skin cancer.