A disease more repulsive and distressing can hardly be conceived than a Rodent Cancer of the face. Commencing in some trifling manner in the skin, and then sometimes producing so little irritation as scarcely to attract notice, it spreads abroad in all directions with a slow but unswerving advance. It grows and ulcerates. It ulcerates but never heals. The skin suffers most widely from its ravages, but no structure arrests its progress. It removes whole organs, but restores nothing. In its front all is healthy: behind it is vacancy and frightful disfigurement. Whilst eroding integument, cartilage, or bone, the disease is not, or is little, painful; but when eyelids disappear, when the eye or the inner ear is invaded, when branches of the fifth nerve are exposed, or are ulcerating, pain and sometimes severe pain, is added to the deformity.”
With these opening lines, cancer specialist Charles Hewitt Moore, MD (1821-1870), of London’s Middlesex Hospital, presented the first medical text devoted to the treatment of cancer and illustrated the text with a photograph. In his 1867 textbook Rodent Cancer: With Photographic and other Illustrations of Its Nature and Treatment, he presented the classic description of basal cell carcinoma, or rodent cancer as it was then best known. Massive destructive lesions of the face were called lupus or rodent in emulation of the effect a wolf or rodent bite would have to the face.
In 1867, Dr. Moore also published in the Medico-Chirgical Transaction, Volume 50, “On the influence of inadequate operations on the theory of cancer.” Because of these publications Dr. Moore has been credited with laying down the modern principles for the surgical treatment of cancer. His surgical accomplishments were already well known and respected. In 1864 he and Charles Murchison, MD (1830-1879), had devised a fairly successful treatment for aneurysms. They introduced the method whereby a wire was passed into an ‘incurable’ aneurysmal sac, resulting in the formation of a fibrin clot in the mass, which helped decrease the growth rate and danger of rupture.
Since the Middle Ages, facial skin cancer was known as ‘noli-me-tangere’ (touch-me-not), as physicians assumed the lesions incurable. Neither surgery nor the use of caustics seemed to stop the disease. In 1755, Jacques Daviel, MD (1696-1762), first claimed that certain types of these cancers could be cured by wide surgical excision; he is best remembered for his 1753 introduction of the modern method of cataract lens extraction. Several noted physicians studied the facially destructive lesions and separated rodent cancer from syphilitic and tubercular forms, as well as ‘epithelioma’ and other cancers, all of which were rapidly growing and metastasized. Dr. Moore’s exhaustive treatise reviewed the prior knowledge of the condition, further distinguished the disease, and described effective treatment.
Dr. Moore advised wide surgical excision to be followed by caustic agents and, when possible, transplanted skin flaps to cover as much of the defect as possible. In most cases of advanced disease, a vulcanite mask was necessary to allow the patient to be seen in public. He concluded this cancer “is eminently a local disease: it is also eminently a curable disease.” Dr. Moore’s favorite caustic was chloride of zinc, which he noted if “applied to the cranium or the dura matter, an epileptiform fit” ensues, in one or more days after the application. Dr. Moore advised surgeons to attempt treating aggressively all but the most advanced cases. As a result of his successes, the most serious cases in England were referred to him.
The patient shown in this photograph arrived at the hospital on May 24, 1864, and was case number two in his text with four photographs to document the study. This 54-year-old man “was living as an incurable patient in the Infirmary of the Uxbridge Union. The disease in him being of 13 years duration… at the first sight of the fellow’s face it seemed hardly possible that any operation could afford him relief….” Some notion of the formidable character of the disease may be obtained from an inspection of the photographic drawings, but these representations fall short of the reality, as they exhibit only the rugged orifice in the face, “the vast cavern amongst the bones behind it not being lighted up and visible….” ■
Excerpted from Oncology: Tumors & Treatment: A Photographic History, The Anesthesia Era 1845-1875 by Stanley B. Burns, MD, FACS. Photograph courtesy of Stanley B. Burns, MD, and The Burns Archive.