Fig. 241.—Macrocheilia.
(From a photograph lent by Sir H. J. Stiles.)
The treatment consists in removing a wedge-shaped portion of the swelling on the same lines as for “strumous lip,” or in employing electrolysis.
Mucous cysts occur as small rounded tumours, projecting from the inner surface of the lip. They are of a bluish colour, and contain a glairy fluid. They are treated by removal of the cyst wall, together with the overlying portion of mucous membrane.
Epithelioma of the lip is of the squamous-celled variety, and is met with either as a fungating wart-like projection, or as an indurated ulcer. It almost exclusively occurs on the lower lip of men over forty years of age. The growth begins about midway between the middle line and the angle of the mouth, either as a horny epidermal thickening, or as a warty excrescence, which bleeds readily and soon ulcerates. The affection is said to be especially common in those who smoke short clay pipes, and it is a suggestive fact that, while epithelioma of the lip is rare in women, the majority of those who do suffer are smokers.
The ulceration spreads along the lip, chiefly towards the angle of the mouth, and downwards towards the chin, and the substance of the lip becomes swollen and indurated ([Figs. 242], [243]). The edges are characteristically raised and hard, and the raw surface is extremely painful, especially when irritated by hot food or fluids. The growth is liable to spread to the mucous membrane and gum, and to invade the mandible. The disease spreads early to the submental and submaxillary glands, which are best felt with one finger inside the mouth, under the tongue, and another outside, behind the mandible. The infected glands tend to become fixed to the bone, and while at first extremely hard, so much so that they simulate a bony tumour of the jaw, they later soften, liquefy, and fungate ([Fig. 244]). Metastasis to internal organs is rare. Unless removed by operation, the disease usually proves fatal in from three to three and a half years.
Fig. 242.—Squamous Epithelioma of Lower Lip in a man æt. 55.
(Mr. D. M. Greig's case.)
