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Melanoma: Histological diagnosis and prognosis
300
Journal of the American Academy of Dermatology
Book reviews
a cutaneous eruption may be monomorphic, i.e., consisting of a single type of primat3, morphologic lesion (e.g., papules in psoriasis) is often addressed in the usual English language textbook of dermatology for students. The distinction between true and false polymorphism, seldom present in our textbooks for students, is succinctly articulated and examples are given. Also, methods for examination of a patient with skin disease and principles of therapy are presented. "Psychotherapy of dermatological patients begins as soon as they am admitted to tim clinic or when they visit the out-patient clinic." "The word is a potent therapeutic factor in many dermatoses . , ," Advice on the question of the "physician's secret" is also given. The section on therapy will appear strikingly different to most North American readers. In addition to the voltage regimen to be prescribed for electric sleep, one may give tablets of camphor bromide for pruritus. Valerian tincture is one of the various sedative agents "used extensively in dermatology." Perhaps the most likely acquaintance with valerian for American medical students would be the pleasant diversion of attending the screenplay Mttrder on the Orient Express based on the book by Agatha Christie. Fangotherapy, treatment with therapeutic (often heated) mud, and ozocerite therapy, application of a heated (45 ~ 60 ~ C) oil with a high heat capacity, will also be of interest to the reader. Much of the section on specific skin diseases is devoted to infectious diseases that involve the skin. While some differences of opinion obtain, the reader will find this largely familiar territory. Clinical "pearls" abound. Ever heard of Gorchakov-Ardy sign in scabies? When an intact bulla of pemphigus vulgaris is pressed and the fluid separates the adjacent epidermal areas, enlarging the bulla on the periphery, whose sign is it? AsboeHansen's sign, not Nikolsky's. The latter part of the book describes venereal diseases, especially syphilis. The classification and description of syphilis are extremely detailed. Finally, a brief supplement, which includes "rare dermatoses," gives one page to "porphyrin disease," although acknowledging that there are several forms.
In a foreign textbook for foreign medical students, one could ahnost predict issues to quibble over. Although Soviet dermatology has had a different phylogeny from ours, the areas in which Soviet and American dermatologies are in agreement are many. The areas of difference represent an important resource for both Soviet and American dermatologists. Exploration and research in these areas should provide new insights and syntheses which will enhance and improve dermatology internationally. With this view in mind, and although 1 cannot suggest this textbook for American medical students, i strongly recommend this work to all practicing clcmmtologists. Here are new therapies to evaluate and new ideas to oxanline.
,Iollalha/1 K. Wilkin, M.D. Richmoml, VA Melanoma: Histoh)gical diagnosis and prognosis Vincent ,I. McGovern, M.D., New York, 1983, Raven Press. 197 pages. $49. The quest continues for a book that will make the histologic diagnosis of malignant melanoma easier. Of the many entries into the race, l believe Dr. McGovern's tiny treatise comes closest to being a "malignant melanoma made simple" book. This is meant as absolute praise, not criticism. Virtually every dermatologist has ample clinical writings on malignant melanoma available in hundreds of sources. Few want to read about the tyrosinase controversy when confronted with a tough slide. What 1 want (and what 1 know my colleagues want) is twofold: good pictures and bits of wisdom from an experienced melanoma student. Dr. McGovern provides this superbly. He has managed to skirt most of the controversial issues in melanoma today, including melanoma in situ, dysplastic nevus, and the clinical subtyping of melanomas. Although he addresses all these issues, he does so in such a fair way that no matter what your opinions are, he probably has avoided offending you. Three concepts seem especially well developed. Dr. McGovern removes the mystm2r surrounding an undisputably benign dermal nevus with overly-
Volume 9 Number 2 August, 1983
Book reviews
ing epidermal lnelanocytic dysplasia. His many photographs of this phenomenon convinced me this is simply part of the natural history of many nevi. He also provides a clear contrast between Spitz nevi, spindle cell non-Spitz nevi, and malignant melanomas resembling each of these entities. Finally, his 15-page chapter on "Sources of Difficulty in the Diagnosis of Benign Melanocytic Lesions" addresses many of the histologic items that I find most troublesome. The book is ahnost wholly histologic. Six pages am devoted to clinical prognostic factors and five to therapy. Both am too short to do justice to these vital areas, but they are not needed Ibr the main task of this book--the histologic diagnosis of melanoma. If you are an amateur dermatopathologist (as I am) and want just one book to use when studying pigmented lesions microscopically, this is the one.
Walter H. C. Bm'gdosf, M.D. Oklahoma City, OK
Pesticides studied in man W..I, Hayes, Ph.D., Btlltimore, 1982, The Williams & Wilkins Co. 672 pages. $49.95. Dermatologists as a lot consider themselves efficient, organized, and practical. Why then a review on an arcane subject such as pesticides. We are often asked to patch test with pestic i d e s - a n d are as often fearful to do so because of the concern of their acute toxicity. This book succinctly (in spite of 672 pages) allows one to ascertain rapidly the comparative toxicity and thus decide to test or not to test--as well as not to exceed an appropriate dose. The chapters are largely chemical class oriented, allowing for efficient use for this purpose. Further, some dermatologists want to know even more about skin contact--and the restllts thereof-with these chemicals. Each section makes comprehension easy through its organization: ( 1) a concise summary of the nomenclature, chemistry, formulations, and uses; (2) the biochemistry and animal toxicity data most relevant to man; and (3) the experiences with the compound in man. This book, combined with Dr. Hayes' previous "Toxicology of Pesticides," provides a powerful
301
informational (and cerebration) tool for the dermatologist doing patch testing and for the dermatotoxicologist.
Howard 1. Maibach, M.D. San Francisco, CA
An atlas of skin biopsy. Diagnosis by light and immuno microscopy of vesico-bullous, connective tissue disorders and vaseulitis of the skin Raghunath P. Misra, M.D., and I. Daniel Sanusi, M.D., Springfield, [L, 1983, Charles C Thomas, Publisher. 103 pages. $22.75. In the authors' preface they state that the intended use of this atlas is as a "bench reference by general pathologists interested in dermatopathof ogy, residents and senior medical students, and those who wish to be more familiar with the recent advances in immunodermatology." For that particular audience, this atlas may be well suited. Most practicing dermatologists or dermatopathof ogists will find it brief and too elementary for their purposes. The book is billed as an atlas but does have several pages of text concerning each subject. Each topic is subdivided among clinical manifestations, histologic features, histologic differential diagnosis, immunofluorescence, and immunopathology. Thirteen entities are treated, varying from the expected pemphigus vulgaris, pemphigoid, dermatitis herpetiformis, erythema multiforme, and chronic bullous disease of childhood to more enigmatic entries such as lichen planus and psoriasis vulgaris--subjects which are neither (typically) bullous or vasculitic nor "connective tissue diseases." Other subjects covered include lupus erythematosus, systemic sclerosis, and mixed connective tissue disease. The single chapter on "cutaneous vasculitis" covers three types: leukocytoclastic vasculitis, mixed cryogtobulinemia, and urticarial vasculitis. References and several tabulated appendices are included, as well as a self-assessment quiz. Each subject is accompanied by full-page photomicrographs of typical light and immunofluorescent microscopy changes characteristic of the disease. The photographs are of good quality.
Journal of the American Academy of Dermatology
Book reviews
a cutaneous eruption may be monomorphic, i.e., consisting of a single type of primat3, morphologic lesion (e.g., papules in psoriasis) is often addressed in the usual English language textbook of dermatology for students. The distinction between true and false polymorphism, seldom present in our textbooks for students, is succinctly articulated and examples are given. Also, methods for examination of a patient with skin disease and principles of therapy are presented. "Psychotherapy of dermatological patients begins as soon as they am admitted to tim clinic or when they visit the out-patient clinic." "The word is a potent therapeutic factor in many dermatoses . , ," Advice on the question of the "physician's secret" is also given. The section on therapy will appear strikingly different to most North American readers. In addition to the voltage regimen to be prescribed for electric sleep, one may give tablets of camphor bromide for pruritus. Valerian tincture is one of the various sedative agents "used extensively in dermatology." Perhaps the most likely acquaintance with valerian for American medical students would be the pleasant diversion of attending the screenplay Mttrder on the Orient Express based on the book by Agatha Christie. Fangotherapy, treatment with therapeutic (often heated) mud, and ozocerite therapy, application of a heated (45 ~ 60 ~ C) oil with a high heat capacity, will also be of interest to the reader. Much of the section on specific skin diseases is devoted to infectious diseases that involve the skin. While some differences of opinion obtain, the reader will find this largely familiar territory. Clinical "pearls" abound. Ever heard of Gorchakov-Ardy sign in scabies? When an intact bulla of pemphigus vulgaris is pressed and the fluid separates the adjacent epidermal areas, enlarging the bulla on the periphery, whose sign is it? AsboeHansen's sign, not Nikolsky's. The latter part of the book describes venereal diseases, especially syphilis. The classification and description of syphilis are extremely detailed. Finally, a brief supplement, which includes "rare dermatoses," gives one page to "porphyrin disease," although acknowledging that there are several forms.
In a foreign textbook for foreign medical students, one could ahnost predict issues to quibble over. Although Soviet dermatology has had a different phylogeny from ours, the areas in which Soviet and American dermatologies are in agreement are many. The areas of difference represent an important resource for both Soviet and American dermatologists. Exploration and research in these areas should provide new insights and syntheses which will enhance and improve dermatology internationally. With this view in mind, and although 1 cannot suggest this textbook for American medical students, i strongly recommend this work to all practicing clcmmtologists. Here are new therapies to evaluate and new ideas to oxanline.
,Iollalha/1 K. Wilkin, M.D. Richmoml, VA Melanoma: Histoh)gical diagnosis and prognosis Vincent ,I. McGovern, M.D., New York, 1983, Raven Press. 197 pages. $49. The quest continues for a book that will make the histologic diagnosis of malignant melanoma easier. Of the many entries into the race, l believe Dr. McGovern's tiny treatise comes closest to being a "malignant melanoma made simple" book. This is meant as absolute praise, not criticism. Virtually every dermatologist has ample clinical writings on malignant melanoma available in hundreds of sources. Few want to read about the tyrosinase controversy when confronted with a tough slide. What 1 want (and what 1 know my colleagues want) is twofold: good pictures and bits of wisdom from an experienced melanoma student. Dr. McGovern provides this superbly. He has managed to skirt most of the controversial issues in melanoma today, including melanoma in situ, dysplastic nevus, and the clinical subtyping of melanomas. Although he addresses all these issues, he does so in such a fair way that no matter what your opinions are, he probably has avoided offending you. Three concepts seem especially well developed. Dr. McGovern removes the mystm2r surrounding an undisputably benign dermal nevus with overly-
Volume 9 Number 2 August, 1983
Book reviews
ing epidermal lnelanocytic dysplasia. His many photographs of this phenomenon convinced me this is simply part of the natural history of many nevi. He also provides a clear contrast between Spitz nevi, spindle cell non-Spitz nevi, and malignant melanomas resembling each of these entities. Finally, his 15-page chapter on "Sources of Difficulty in the Diagnosis of Benign Melanocytic Lesions" addresses many of the histologic items that I find most troublesome. The book is ahnost wholly histologic. Six pages am devoted to clinical prognostic factors and five to therapy. Both am too short to do justice to these vital areas, but they are not needed Ibr the main task of this book--the histologic diagnosis of melanoma. If you are an amateur dermatopathologist (as I am) and want just one book to use when studying pigmented lesions microscopically, this is the one.
Walter H. C. Bm'gdosf, M.D. Oklahoma City, OK
Pesticides studied in man W..I, Hayes, Ph.D., Btlltimore, 1982, The Williams & Wilkins Co. 672 pages. $49.95. Dermatologists as a lot consider themselves efficient, organized, and practical. Why then a review on an arcane subject such as pesticides. We are often asked to patch test with pestic i d e s - a n d are as often fearful to do so because of the concern of their acute toxicity. This book succinctly (in spite of 672 pages) allows one to ascertain rapidly the comparative toxicity and thus decide to test or not to test--as well as not to exceed an appropriate dose. The chapters are largely chemical class oriented, allowing for efficient use for this purpose. Further, some dermatologists want to know even more about skin contact--and the restllts thereof-with these chemicals. Each section makes comprehension easy through its organization: ( 1) a concise summary of the nomenclature, chemistry, formulations, and uses; (2) the biochemistry and animal toxicity data most relevant to man; and (3) the experiences with the compound in man. This book, combined with Dr. Hayes' previous "Toxicology of Pesticides," provides a powerful
301
informational (and cerebration) tool for the dermatologist doing patch testing and for the dermatotoxicologist.
Howard 1. Maibach, M.D. San Francisco, CA
An atlas of skin biopsy. Diagnosis by light and immuno microscopy of vesico-bullous, connective tissue disorders and vaseulitis of the skin Raghunath P. Misra, M.D., and I. Daniel Sanusi, M.D., Springfield, [L, 1983, Charles C Thomas, Publisher. 103 pages. $22.75. In the authors' preface they state that the intended use of this atlas is as a "bench reference by general pathologists interested in dermatopathof ogy, residents and senior medical students, and those who wish to be more familiar with the recent advances in immunodermatology." For that particular audience, this atlas may be well suited. Most practicing dermatologists or dermatopathof ogists will find it brief and too elementary for their purposes. The book is billed as an atlas but does have several pages of text concerning each subject. Each topic is subdivided among clinical manifestations, histologic features, histologic differential diagnosis, immunofluorescence, and immunopathology. Thirteen entities are treated, varying from the expected pemphigus vulgaris, pemphigoid, dermatitis herpetiformis, erythema multiforme, and chronic bullous disease of childhood to more enigmatic entries such as lichen planus and psoriasis vulgaris--subjects which are neither (typically) bullous or vasculitic nor "connective tissue diseases." Other subjects covered include lupus erythematosus, systemic sclerosis, and mixed connective tissue disease. The single chapter on "cutaneous vasculitis" covers three types: leukocytoclastic vasculitis, mixed cryogtobulinemia, and urticarial vasculitis. References and several tabulated appendices are included, as well as a self-assessment quiz. Each subject is accompanied by full-page photomicrographs of typical light and immunofluorescent microscopy changes characteristic of the disease. The photographs are of good quality.