As the physician himself advances beyond middle age there is one experience which recurs with ever increasing frequency. Some contemporary will come to him, exhibiting a lesion of the skin, and say, "What is this scaly patch on my face? It has been coming and going for several months. Could it be cancer?" or, "This little ulcer where my glasses rub doesn't seem to heal. Is it dangerous?" or perhaps, "This mole is growing and getting sore. What should be done about it?" Seafaring men and others who are exposed to sun and storm are prone to develop such growths on the unprotected surfaces of the face, neck, and hands, so they are very common among naval officers and men. It is because I have been asked these questions so many hundreds of times and have seen so many tragedies associated with them that I essay to answer them in plain words.
Not many years ago, one of the most prominent and best loved officers of the Navy died after months of suffering from a cancer of the face which developed rapidly from a mole near the ear. At any time during the preceding 40 years that growth could have been easily and safely destroyed. Suddenly it began to grow rapidly and when its removal was eventually attempted, it was too late, for the cancer had involved areas that were out of surgical reach. The number of similar cases that we see among our older officers would come as a great surprise to those who are not engaged in active work in a large naval hospital.
The title of this paper, while not a universal truth, is as accurate as most generalizations and sufficient for our purposes, for it is the apparently innocent blemishes present after the age of 40 that interest us at present.
Cancer is the unrestrained growth of cells that are otherwise similar to normal cells of the body. What causes this uncontrolled growth we do not know nor do we even know what the factors are that normally limit cell growth. But repeated irritation, whether chemical, actinic, or mechanical, of any area undoubtedly favors cellular overgrowth. An example of chemical irritation is found in the hands of the engineer when cracks in the skin are constantly exposed to oil. The actinic is common to all who stand deck watches in sun and wind. The mechanical is present over the bridge of the nose where the glasses press, on the lip where the cigarette or pipe rests, or on the tongue where it constantly rubs against a rough tooth.
Ninety per cent of skin cancers occur on the face or neck and a large majority of them develop from apparently innocent blemishes already present. So removal of these growths is an important step in cancer prevention even though not more than 5 per cent of them would become malignant. Hertzler compares them to the small boy playing with a loaded gun who has not shot anybody—yet. They are termed precancerous lesions, which means that we do not know whether they will change to cancer or not, but they may.
The common precancerous growths of the face, neck, and hands are warts, moles, and keratosis. Warts are perfectly innocent up to middle age but senile warts frequently become cancerous. It is better to have them removed after you pass 40, especially if they are located where they are frequently rubbed or injured. If you do not care to have them removed, at least watch them carefully and if there should be any increase in size or any ulceration, go at once and ask your doctor’s advice.
Moles are usually pigmented, but the degree of pigmentation is no index of their portent. There is room for honest difference of opinion, whether or not they should be removed. This is because their roots may extend much farther under the skin than their surface showing would indicate. Certainly, if they are so located that they are subjected to injury or irritation, they should be removed. There is an old rule that moles are more dangerous the lower down on the body their situation. If your doctor recommends that yours be removed, do not be offended if he takes a wide area of healthy tissue with the mole. It is necessary, for your protection, to do this since the pigmented cells frequently extend out along the blood vessels for a considerable distance. Anything less than complete removal is worse than doing nothing. It has been compared, in this respect, to dealing with a skunk; one should kill it quickly or leave it alone, nothing but grief comes from irritating it. Pigmented moles do not respond well to radiation treatment.
Brown or yellow scaly patches which appear on the exposed skin of elderly people are called keratosis. Not more than 3 to 5 per cent of these become malignant and the type of cancer that they produce is of a low degree of malignancy, slow growing, and with no tendency to be carried to distant organs. Yet, through neglect, they cause great disfigurement and many deaths. A safe treatment is to cleanse them gently, morning and night, with soap, water and absorbent cotton, then apply a little plain cold cream, olive oil, or castor oil. The danger sign to be watched for is the appearance of a small ulcer, and when this appears the time has come to have it removed as quickly as possible. If you have keratosis, have your doctor look them over at least once a month and do not delay in following his advice if he says they should be destroyed.
It is a general rule that when cancer supervenes upon a benign growth, such as a wart or keratosis, it is much less malignant than when it arises de novo. The more dangerous forms usually appear as elevations on the skin developing into small ulcers which do not heal. Avoid treating such ulcers with iodine, silver nitrate, alum, or anything else. Seek medical advice at once for any ulcer that persists more than a week. Every cancer is a local disease at first and that is the time to destroy it. The time element is of the greatest importance.
Wens or cysts of the skin rarely become malignant but occasionally they give us unpleasant surprises. If a soft wen gradually becomes hard and solid, a change in its nature should be suspected.
Nobody knows why a growth in the mouth should be so much more malignant than a similar one on the face but such is the fact. One third of all cancers of the skin are found on the lower lip and 95 per cent of them are in males. Recent widespread espousal of the cigarette by the ladies may eventually change this latter percentage. Broken, dirty teeth, ill-fitting plates or bridges, and tobacco are to blame for most cancers of the lips, mouth, or 1 tongue. Since they are so highly malignant and so difficult to treat successfully, it is the part of wisdom for those over 40 to give close attention to the condition of their mouths. Rough spots on plates, bridges, fillings, or cavities should be re- , moved. The teeth should be cleaned and inspected frequently. You will find your dentist keenly interested in removing any sources of irritation in the mouth.
To most of those who read these lines, the advice and services of both dentist and physician are free for the asking. You will find them alert to discover and correct dangerous lesions in their earliest manifestations. My purpose is not to imbue anyone with a morbid or excessive fear of cancer but to spread an intelligent knowledge of the danger signals so that we may detect the disease promptly.