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Dermatopathology: Practical & Conceptual January - March 2006
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5. New Heights: An assist to the next (10th) edition of “Lever’s”
Renata A. Joffe, M.D.
Content
Introduction
1. Small plaque parapsoriasis
2. Dysplastic nevus
3. Solar keratosis
4. Inverted follicular keratosis/trichilemmoma
5. Discoid lupus erythematosus vs. systemic lupus erythematosus
6. Lentigo maligna
7. Atopic dermatitis
8. Sebaceous adenoma
9. Muir-Torre syndrome
10. Bowen’s disease
11. Follicular mucinosis/alopecia mucinosa
12. Granuloma faciale and erythema elevatum diutinum
13. Follicular degeneration syndrome
14. Eccrine papillary adenoma
15. Degos’ disease
16. Dermatofibroma
17. Proliferating tricholemmal cyst
18. Erythema multiforme (dermal and epidermal types)
19. Lichen sclerosus et atrophicus vs. morphea
20. Malignant melanoma (classification)
21. Malignant melanoma—ABCD’s
22. Malignant melanoma—wide/deep excision
23. Sentinel node biopsy for melanoma
24. Malignant melanoma: nontumorigenic compartment of primary malignant melanoma (radial growth phase), tumorigenic compartment of primary malignant melanoma (vertical growth phase)
25. Minimal deviation melanoma
26. Nevoid melanoma
27. Malignant melanoma—in infancy and childhood
28. Malignant blue nevus
29. MELTUMP and SAMPUS
30. Bulge activation hypothesis
Conclusion
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2. Dysplastic nevus
Quotation from the 9th edition of Lever's:
"Dysplastic nevi form, clinically and histologically, a continuum extending from a common nevus to a superficial spreading melanoma."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA):
Ackerman AB, Mihara I. Dysplasia, dysplastic melanocytes, dysplastic nevi, the dysplastic nevus syndrome, and the relation between dysplastic nevi and malignant melanomas.
Hum Pathol.
1985 Jan;16(1):87-91.
Ackerman AB, Briggs PL, Bravo F. Dysplastic nevus, compound type vs. Clark's nevus, compound type. In Ackerman AB, Briggs PL, Bravo F, eds.
Differential Diagnosis in Dermatopathology III.
Philadelphia: Lea & Febiger, 1993 :158-161.
No references to ideas of ABA published since 1993. Moreover, no reference was made to
Dysplastic Nevus: Atypical Mole or Typical Myth
(Ackerman AB, Massi D, Nielsen TA. Philadelphia, Ardor Scribendi, 1999), the only volume dedicated exclusively to the subject.
Statements contrary by ABA:
"The perplexing story of the dysplastic nevus and the dysplastic nevus syndrome can be comprehended only in the context of understanding the consistent lack of a repeatable definition of dysplasia and the persistent failure to provide reliable criteria for clinical and histopathologic diagnosis of dysplastic nevus. As a consequence of these rickety underpinnings, it was inevitable that the edifice would collapse, and it did in less than 15 years. The epitaph for dysplastic nevus was written in 1992, and that was published in the Journal of the American Medical Association in 1992. In that report, the panel stated that the term dysplastic nevus had outlived its usefulness and should be abandoned. We concur and advise further that the concepts of dysplasia, dysplastic melanocytes, dysplastic nevus, and the dysplastic nevus syndrome not only be abandoned now, but that they also not be supplanted by equally opaque notions, such as cytologic and architectural atypia, nevus with histologic dysplasia, clinically atypical mole, and atypical mole syndrome."
Ackerman AB, Cavegn BM, Casintahan MF, Robinson MJ.
Resolving Quandaries in Dermatology, Pathology and Dermatopathology.
pp 88. Promethean Medical Press/Waverly, 1995.
Other works of ABA in which the ideas contrary are expressed:
1. Dysplastic Nevus: Message or Massage(video). In www.derm101.com, 2005.
2. Exploding Myths: Melanocytic Neoplasms(video). In www.derm101.com, 2005.
3. Ackerman AB. Enough mysticism about dysplastic nevi!
Dermatopathology: Practical & Conceptual
7(1):86-88, 2001.
4. Ackerman AB. Mythology and numerology in the sphere of melanoma.
Dermatopathology: Practical & Conceptual
6(3): 251-256, 2000.
5. Ackerman AB, Massi D, Nielsen TA.
Dysplastic Nevus: Atypical Mole or Typical Myth?
Philadelphia: Ardor Scribendi, 1999.
6. Massi D, Nielsen T, Ackerman AB. Melanocytic dysplasia, dysplastic nevus, and dysplastic nevus syndrome: myth! Part IV.
Dermatopathology: Practical & Conceptual
(1):38-59, 1997.
7. Massi D, Nielsen TA, Ackerman AB. Dysplastic nevus: National Institutes of Health Consensus Development Conferences, 1983 and 1992—consensus?
Dermatopathology: Practical & Conceptual
2(4):228-236, 1996.
8. Ackerman AB. Editorial. Consensus and consequences.
Dermatopathology: Practical & Conceptual
2(4):207-209, 1996.
9. Ackerman AB, Nielsen TA, Massi D. Dysplastic nevus: atypical mole or monumental myth? Part II.
Dermatopathology: Practical & Conceptual
2(3):157-176, 1996.
10. Frazier R, Massi D, Ackerman AB. "Dysplastic nevus": terminology between 1976 and 1996.
Dermatopathology: Practical & Conceptual
2(2):87-90, 1996.
11. Ackerman AB, Abad-Casintahan MFA, Robinson MJ. Dysplastic nevus: message or massage?
Dermatopathology: Practical & Conceptual
1(1):63-66, 1995.
12. Ackerman AB. A critique of an NIH consensus development conference about "early melanoma."
Am J Dermatopathol.
15(1):52-58 (February) 1993.
13. Ackerman AB, Milde P. Naming acquired melanocytic nevi: normal and atypical, common and dysplastic, or Unna, Miescher, Spitz, and Clark?
Am J Dermatopathol.
14(5):447-453 (October) 1992.
14. Ackerman AB. From active junctional nevus to dysplastic nevus: no boon to children with melanocytic nevi.
Pediatr Dermatol.
9(4):338-339, 1992.
15. Magana-Garcia M, Ackerman AB. Naming acquired melanocytic nevi: Unna's, Miescher's, Spitz's, Clark's.
Am J Dermatopathol.
12(2):193-209, 1990.
16. Clark WH Jr, Ackerman AB. An exchange of views regarding the dysplastic nevus controversy.
Semin Dermatol.
8(4):229-250 (December) 1989.
17. Ackerman AB. What nevus is dysplastic, a syndrome, and the commonest precursor of malignant melanoma? A riddle and an answer.
Histopathology
13:241-256 (September) 1988.
18. Ackerman AB, Elder DE. An exchange of ideas about dysplastic nevi and malignant melanoma.
Am J Dermatopathol.
7:99-105 (Supplement) 1985.
19. Dixon SL, Ackerman AB. Editorial. Some observations, reflections, and questions about dysplastic nevi.
Am J Dermatopathol.
7:AI7-A25 (Supplement) 1985.
20. Ackerman AB, Mihara I. Dysplasia, dysplastic melanocytes, dysplastic nevi, the dysplastic nevus syndrome, and the relation between dysplastic nevi and malignant melanomas.
Hum Pathol.
16:87-91 (January) 1985.
21. Ackerman AB. Critical commentary on statements in "precursors to malignant melanoma."
Am J Dermatopathol.
6:181-183 (Supplement, Summer) 1984.
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