The Journal of Cutaneous Diseases, Vol. 26: March, 1908 (Classic Reprint)

Excerpt from The Journal of Cutaneous Diseases, Vol. 26: March, 1908

S. M., sixty-nine years old, a traveling salesman by occupation, in excellent general health, came under my observation in January of this year, seeking advice for an affection of the legs which presented the following features: On the dorsum of the left foot and the anterior surface of the leg were numerous round, oval, and irregu larly-shaped, slightly elevated, or on a level with the healthy skin, very dark-brown and slate-colored, for the most part smooth, but in places Slightly scaly, firm patches. On the calf the disease consisted of many pea to hazel-nut - Sized, confluent firm nodules similar in color to the patches on the anterior surface of the leg, forming a large uneven patch covering the entire calf. Here and there were a few coin - sized, depressed, scaly, less - deeply pigmented areas which according to the statement of the patient, represented patches of nodules which had undergone partial involution. Over the outer malleolus was a single nut-sized, pedunculated tumor, projecting considerably above the surface, which gave the patient much annoy ance because of the pressure exerted on it by the shoe, and the fre quent injury which it suffered, owing to its exposed situation, by being caught by the clothing and the bedclothing, considerable hzemorrhage taking place from it at times. Upon the right leg the disease was much less extensive, the lesions being comparatively small in number, smooth, flat, without any tendency to the formation of tumors. The left leg was several inches larger in circumference than the right one, was very firm to the touch, but did not pit on pressure. There was marked itching and some burning, but never positive pain, although walking was somewhat interfered with by the swelling of the left leg and stiffness of the skin about the ankles. The disease had begun fourteen years previously, with intense itching at the root of the toes and smooth pigmentation of the dorsum of the foot, and had remained limited to the left extremity until two years ago, when it began to appear on the right foot and leg. The numerous tumors on the left calf were first noticed some five or six years ago. With the exception of a single thumbnail sized patch on the Inner surface of the left thigh, the disease was strictly limited to the legs and feet.

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