The ulcerative forms of syphilis and tuberculosis seem to be met with more in the lower than in the upper lip; likewise is this true of burns and acute traumatisms. Defects in the lower lip are, therefore, due principally to the extirpation of carcinomata or other malignant growths and less frequently to the other causes mentioned. The classification and extent of such involvement has already been referred to. In operations intended to extirpate a growth of malignant nature the incisions should be made sufficiently distant from the neoplasm to insure of unaffected or uninvolved tissue to avoid a recurrence of the disease. These growths appear at first in wartlike formation, becoming thicker in time, and bleeding readily upon interference. They seem to develop horizontally, and invariably in a direction toward the angle of the mouth. There is more or less involvement of the lymphatic glands, especially of the submaxillary, quite early in the attack. An early extirpation of such growths is to be recommended, and while it is true there may be a question of primary syphilitic induration instead of the malignant variety no harm is done if the diseased area be at once excised. This is especially true of patients beyond the thirtieth year. When such indurations occur before that age the patient may be put under a proper course of treatment to determine the nature of the infiltration for a period of three or four weeks; if this does not resolve it operative measures should be resorted to. It is to be remembered that syphilitic induration may involve the upper as frequently as the lower lip, a fact not as likely referable to cancer. In sixty-seven cases reported from Billroth’s Clinic there were sixty-five cases of carcinoma of the lower lip and only two of the upper. Yet this proportion hardly applies to the experience of most surgeons. The age factor is not to be overlooked. The author does not mean to claim that the differential diagnosis of these diseases is at all difficult, yet in patients beyond the admissible age early and radical treatment should not be neglected, considering what great amount of misery and suffering, not to mention disfigurement, can be overcome by prompt action. Usually these neoplasms, when superficial, are found directly in the prolabium, are unilateral, and occupy a place midway between the angle of the mouth and the median line of the lip. =Richerand Method.=—Very small or superficial neoplasms may be removed by lifting up the growth with a fixation forceps and cutting away the convexity so established as deeply as necessary with the half-round scissors, or the faulty area is neatly outlined in spindle form (Richerand) with the bistoury, as in Fig. 206, and then excised according to the method selected by the operator. The wound is sutured horizontally, as shown in Fig. 207. [Illustration: FIG. 206. FIG. 207. RICHERAND METHOD.]