usually on the penis or labia minora, or on the groin, as an insignificant circumscribed, nodular thickening and elevation of the skin. The affected area, which on the whole is elevated above the surrounding healthy skin, and is covered with a very delicate, pinkish, easily-rubbed-off epithelium, excoriates readily, exposing a surface prone to bleed and break down, although rarely ulcerating deeply. The disease advances in two ways: by continuous
Fig. 94.—Ulcerating granuloma of pudenda in the male.
eccentric peripheral extension, and by auto-infection of an opposing surface. In its extension it exhibits a predilection for warm and moist surfaces, particularly the folds between the scrotum and thighs, the labia, and the flexures of the thighs (Fig. 94). Its extension is very slow, years elapsing before it covers a large area. Concurrently with peripheral extension a dense, contracting, uneven, readily-breaking-down scar forms on the surface travelled over by the coarsely or finely nodulated elevated new growth which constitutes the peripheral part of the diseased area.
