. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. characterized like cutaneouscarcinoma by its hard, raised, fixed borders, crateri-form base and sanious discharge. A hard infiltra-tion develops round the tumor which is usually fixedto the thorax. Small nodular thickenings of the ad-jacent unbroken skin sometimes constitute the firstsign of commencing general cutaneous dissemination(Fig. 11). In this way the whole mamma may betransformed into a large ulcer (Fig. 15). In other cases a tumor is gradually developedinvolving the whole br
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. characterized like cutaneouscarcinoma by its hard, raised, fixed borders, crateri-form base and sanious discharge. A hard infiltra-tion develops round the tumor which is usually fixedto the thorax. Small nodular thickenings of the ad-jacent unbroken skin sometimes constitute the firstsign of commencing general cutaneous dissemination(Fig. 11). In this way the whole mamma may betransformed into a large ulcer (Fig. 15). In other cases a tumor is gradually developedinvolving the whole breast without breaking throughexternally. The skin, however, may be infiltratedand the redress may be mistaken for inflammatoryinfiltration (Figs. 14 and 16). These leathery infil-trating forms of breast cancer finally envelop thewhole mammary region like a cuirass (Fig. 15). In the infiltrated skin these often appear small,pin-point disseminations of the carcinoma (Fig. 15,right side), which by confluence give rise to a nodu-lar infiltration of the whole thorax (Fig. 14). 18 Bockenheimer, Atlas. Tab. PifT. 12. Carcinoma mammillae. Kcbnan Company, New-York. In cancers which are poor in cells (scirrhous) themammary gland is often diminished in size byshrinking, and the skin becomes puckered over thetumor by cicatricial contraction (Fig. 10). Differential Diagnosis. Ulcerated cancers ofthe breast and those with hard, raised infiltrationare difficult to mistake, but small tumors in the sub-stance of the breast have to be diagnosed from inter-stitial mastitis, benign tumors (fibro-adenomas, cystsand mixed tumors) and abscesses, in which there isfrequently deceptive induration. The age of the pa-tient, the continuous growth of the nodules, theappearance of hard, lymphatic glands in the axilla,and the frequent occurrence of emaciation andcachexia even in small cancers assist in the diagnosis,which in doubtful cases can be established by exci-sion of a piece for examination. Sarc
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