#Describe the clinical appearances and course of the deep-seated variety of epithelioma.# The deep-seated variety starts from the superficial form, or it begins as a tubercle or nodule in the skin. When typically developed, a reddish, shining tubercle or nodule, or area of infiltration, forms in the skin or subcutaneous tissue. In the course of weeks or months superficial or deep-seated ulceration takes place; the ulcer having hardened, and, as a rule, everted edges. The surface is reddish and granular, and secretes an ichorous discharge. The infiltration spreads, the ulcer enlarges both peripherally and in depth--muscle, cartilage and bone often becoming invaded. The neighboring lymphatic gland may become implicated, pains of a burning or neuralgic type are experienced, and from septicaemia, marasmus, or involvement of vital parts, death eventually ensues. #Describe the clinical appearances and course of the papillomatous variety of epithelioma.# The papillomatous type usually arises from the superficial or deep-seated variety, or it may begin as a papillary or warty growth. When fully developed, it presents an ulcerated, fissured and papillomatous surface, with an ichorous discharge which dries to crusts. It is slowly progressive, and sooner or later may develop a malignant tendency. #Upon what parts is epithelioma commonly observed?# About the face, especially the nose, eyelids and lips; and also about the genitalia. It may involve any part. #At what age is epithelioma usually noted?# It is essentially a disease of middle and late life, although it is exceptionally met with in the young. #What is the cause of epithelioma?# The etiology is obscure. It is not, as a rule, inherited. Any locally irritated tissue may be the starting point of the disease. #State the pathology.# The process consists in the proliferation of epithelial cells from the mucous layer; the cell-growth takes place downward, in the form of finger-like prolongations or columns, or it may spread out laterally, so as to form rounded masses, the centres of which usually undergo horny transformation, resulting in the formation of onion-like bodies, the so-called cell-nests or globes. The rapid cell-growth requires increased nutriment, and hence the bloodvessels become enlarged; moreover, the pressure of the cell-masses gives rise to irritation and inflammation, with corresponding serous and round-cell infiltration. #How would you distinguish epithelioma from syphilitic ulceration, wart, and lupus vulgaris?# From syphilis it is to be differentiated by the history, duration, character of the base and edges, its comparative slow progress, its usually slight, viscid discharge, often streaked with blood, and, if necessary, by the therapeutic test.