It has been favorably commented on at the recent meetings of the American Board of Otolaryngology that the younger otolaryngologists are examining the oral cavity with greater care than did the applicants of ten years ago who came before the board. While not all otolaryngologists are interested in or even qualified for oral surgery, all should thoroughly examine the mouth as a necessary part of any complete examination. The tongue depressor can be, and often is, used too soon to hold the tongue down and thus obscures pathologic lesions which should be examined and diagnosed early.Many of the early lesions of malignant disease can be readily seen, but too many patients with such lesions put off having anything done until pain and external deformity compel them to seek relief. This is the experience of most physicians and surgeons on the staffs of state hospitals, so that the results following late diagnoses, operation and irradiation leave much to be desired, especially so far as cures are concerned. However, many patients have been made more comfortable and their lives prolonged. There are many factors which influence or even decide the prognosis and treatment of malignant neoplasms, as enumerated by McCarty,1 such as the presence or absence of involvement of the lymph nodes, fixation of the growth, anatomic location, renal efficiency, the presence or absence of anemia, cardiac efficiency, size, age, duration and direction of the growth, loss of weight, lymphocytic infiltration, fibrosis, hyalinization and cellular differentiation. To these we should like to add previous operations and irradiation.Age.-In this series, the ages ranged from 2 weeks for the youngest patient to 81 years for the oldest. The average age in years was 49 plus. There were 4 patients of the ages of 2 weeks, 2 years, 8 years and 16 years respectively.Sex.-There were 3 female and 16 male patients in the series, which corresponds with the more frequent occurrence of malignant disease in males.Occupation and Nationality.--These were so varied as to be of no importance, especially in a small series.Biopsy.-In 11 cases a biopsy was performed to complete the diag¬ nosis. In the 8 cases in which biopsy was not done, the patients did not come to operation.Type of Tumor.-In 13 cases a clinical diagnosis of carcinoma was made. In 4 of these the tumors were squamous cell carcinomas, and in 1 both squamous and basal cell lesions were present. We encountered 1 fibrosarcoma and 2 giant cell sarcomas, which, of course, are not true sarcomas ; 1 malignant growth of undetermined type in a 2 year old child ; 1 dentigerous cyst, and 1 sublingual cyst.Metastasis.-In 11 cases there was metastasis at least to the cervical 1935.
