. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. .Cachexia occurs early, and the patients are usuallyof advanced age. The diagnosis of carcinoma depends on the hardmultiple glandular enlargement, which affects thewhole nape of the neck. This usually occurs laterand is not so hard in sarcoma. Treatment. This consists in extirpation of thecarcinoma, and involves removal of part of the exter-nal table of the skull on account of the tumor beingfixed to it. The extensive space left by removal ofthe tumor can be sutured after making two l
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. .Cachexia occurs early, and the patients are usuallyof advanced age. The diagnosis of carcinoma depends on the hardmultiple glandular enlargement, which affects thewhole nape of the neck. This usually occurs laterand is not so hard in sarcoma. Treatment. This consists in extirpation of thecarcinoma, and involves removal of part of the exter-nal table of the skull on account of the tumor beingfixed to it. The extensive space left by removal ofthe tumor can be sutured after making two longlateral incisions over both ears and undermining ofthe scalp. The spaces left by the lateral incisionscan be repaired by Thierschs grafts. The glands inthe nape of the neck must also be removed. On account of the early appearance of glandularmetastases the excision of especially indurated seba-ceous cysts is indicated. Moreover, as there isalways a possibility of malignant degeneration, itis advisable to remove every sebaceous cyst bydissecting it out, so as to avoid recurrence. 26 Bockenheimer,
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