This exhibit shows that early treatment of epitheliomas, basal cell tumors, or whatever one calls them, is necessary to prevent destruction. I have long felt that whether one removes them by radium or by diathermy they should be covered immediately by a flap. Probably that will be regarded as radical, but the records are showing entirely too many recurrences from just plain local treatment without covering up the scar. I am using a flap in all my cases except those around the lower eyelids. Particularly if one puts radium around the ear where the cartilage will become affected by radium, one has a great deal of trouble and the tumor is prone to recur. I take them out, put a flap over the wound and have fewer recurrences. On basal cell tumors I do it immediately, differing from Dr. New ; I also do it on the squamous cell tumors, which I cover within a few weeks, or as soon as conditions allow. I get recurrences, but they are less numerous than if I let the scar go for eight or nine months before covering up. I cover basal cell tumors as soon as pos¬ sible, because I know they will give a larger percentage of nonrecurrences.I also cover squamous cell tumors long before eight months, because I get a higher percentage of cures if I cover the area early instead of disregarding the granulated area with the secretion that comes from the wound, and the irritation there. If I do not cover them up I get recurrences under them even after eight months. After covering them, I apply roentgen or radium treatment, particularly radium, to the areas drained by these epitheliomas, whether they are basal cell or otherwise. If one will follow carefully a large series of cases, say fifty, it is surprising how many métastases will occur. When they do occur it is too late. I have been able, I believe, to prevent a number of these secondary métastases by applying radium to the surrounding area.Dr. J. Shelton Horsley, Richmond, Va. : About eleven years ago I noticed that, if a transplant was made of a flap taken at a distance from the region of an excised basal cell cancer, it seemed to have an inhibitory effect on the recurrence of the cancer. A basal cell cancer practically never metastasizes, whereas a squamous cell cancer does. There must be a reason for this. It seems probable, though it has not been demon¬ strated as an actual fact, that a basal cell cancer, in order to grow, must destroy something that is inhibitory in its adjacent tissue. For instance, if we have a lot with dry broom-sedgewhich would be squamous cell cancer-we can start a fire any¬ where in the lot, but if it is damp it has to dry out around the margin of the fire in order to spread. That would be basal cell cancer. This seems to be true because basal cells are just as small as squamous cells and they doubtless enter the lym¬ phatics as the cells of squamous cell cancer do, but they apparently arrive in a nonreceptive area. By transplanting a flap from a distance with this inhibitory power unimpaired, one establishes an inhibitory influence on the recurrence of th...
