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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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4. Inverted follicular keratosis/trichilemmoma
Quotation from the 9th edition of Lever's:
"Although some authors merely concede that irritated seborrheic keratoses and inverted follicular keratoses may be histologically indistinguishable others regard the two disorders as identical. Because of their histologic similarity and particularly because of the highly specific appearance of the squamous eddies that occur in these two conditions, they are best regarded as identical."
"Solitary trichilemmoma, first recognized as an entity in 1962, generally is a small tumor, 3 to 8 mm in diameter, occurring usually on the face."
"Molecular studies have not supported the notion that all trichilemmomas result from human papillomavirus infection."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Rather than give curious names such as inverted follicular keratosis, tricholemmoma, and desmoplastic tricholemmoma to morphologic variants of regressing verrucae vulgares on a face, it is preferable to acknowledge them as the warts they truly are."
Ackerman AB, Cavegn BM, Casintahan MF, Robinson MJ.
Resolving Quandaries in Dermatology, Pathology and Dermatopathology.
pp 157. Promethean Medical Press/Waverly, 1995.
Other works of ABA in which the ideas contrary are expressed:
1. A Novel Concept of Histologic Aspects of the Hair Follicle (video). Available at: www.derm101.com, 2005.
2. Ackerman AB, Mones J.
Ackerman"s Resolving Quandaries in Dermatology, Pathology, and Dermatopathology,
2nd Vol. 393-396 pp, Ardor Scribendi, 2001.
3. Ackerman AB, Cavegn BM, Robinson MJ, Abad-Casintahan MFA.
Ackerman"s Resolving Quandaries in Dermatology, Pathology, and Dermatopathology,
1st Vol, 155-157 pp, Waverly: Promethean Medical Press;1995.
4. Ackerman AB, de Viragh PA, Chongchitnant N.
Neoplasms With Follicular Differentiation.
Philadelphia: Lea & Febiger;1993:359-420.
5. Spielvogel RL, Austin C, Ackerman AB. Inverted follicular keratosis is not a specific keratosis but a verruca vulgaris (or seborrheic keratosis) with squamous eddies.
Am J Dermatopathol.
1983 Oct;5(5):427-442.
6. Phillips ME, Ackerman AB. "Benign" and "malignant" neoplasms associated with verrucae vulgares.
Am J Dermatopathol.
4:61-84 (February) 1982.
7.Ackerman AB, Wade TR. Tricholemmoma.
Am J Dermatopathol
. 2:207-224 (Fall) 1980.
8. Ackerman AB. Trichilemmoma.
Arch Dermatol.
1978 Feb;114(2):286.
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