WE have seen three examples of a tumour of the foot which does not appear to be described in the literature. Probably, as we shall see, it is no more than a carcinoma of the skin. But two at least of our cases (One we Only know as a specimen) caused both clinicians and pathologists concerned considerable difficulty in diagnosis and treatment, and we and characteristically sickly smell of sebum oozed out of these sinuses like toothpaste from a tube. The mass extended right through the foot, and appeared on the size and extent it did not appear to be destroying bone, tendon, nerve, or any other important structure. It had been present two years, and had recurred after an excision elsewhere a year earlier. Several biopsies had failed to provide a firm diagnosis. Search for possible very unusual variant on the old theme of squamous dorsum (Fig. 279) between the toes, but despite its FIG. 278.-Care I . Plantar view of the foot when first The small depressions on the summits of several of seen. the hossy projections are sinus openings.have some evidence that similar tumours, though rare, have been seen elsewhere and caused similar difficulties ; we believe therefore they deserve description. CASE REPORTSCase I.-CLINICAL HISTORY.-A man of 64 presented himself to one of us (I. A.) in 1950 with a very curious swelling of the fore part of the left foot (Figs. 278, 279). It formed a bulbous mass on the sole, covered with skin but with many sinuses, most of the latter opening each at the apex of a separate bulge. It was ' squashy ' in consistency, and on pressure greasy material with the appearance FIG. z79.-Cuse I . Dorsal view. (The small black lesion is a benign melanoma, unrelated to the main tumour.)infective agents proved fruitless. Finally, the mass continuing to enlarge and the foot being useless, mid-leg amputation was carried out. Convalescence was complicated by fracture through an area of Paget's disease in the tibia of the opposite leg, but the patient was ultimately able to walk well and is now, three years after the operation, fit and free from metastases. PAmoLoGY.-Several biopsies were available for study, but they add no information, and description will be confined to the amputation specimen. This showed no abnormalities except for the mass in the foot. The external appearance of this corresponded to the clinical description. The foot was frozen and then sawn into sagittal slices (Fig. 280). The tumour was then seen to be well-defined, filling and expanding the soft tissues of

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