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Rh a scar. This distinction, however, is of little value, since the growth is the same in either case, and it is impossible to assert, in any case of spontaneous keloid, that it has not been preceded by some prick or slight injury to the skin. A distinction, however, may be justly drawn between keloid and a hypertrophic cicatrix. Many scars, especially those following burns, are prone to pucker and bulge until a tumor is formed which looks very much like keloid, being rounded, smooth, reddened, and often very firm and even painful. But while keloid is characterized by a marked tendency to enlarge its area by the forma-

. 58.—Keloid.

tion of claw-like processes suggestive of a crab, and to persist indefinitely, the hypertrophic cicatrix never extends beyond the limits of the scar tissue and tends to a gradual disappearance rather than to an increase in size.

Keloid is usually single, but many tumors may be present, and in some cases these attain considerable size. The growth is commonly painful when squeezed or pressed, and sometimes a continuous burning or pricking sensation is experienced. A spontaneous disappearance of the tumors has been reported, but this is exceptional. Keloid occurs at all ages, affects various