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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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9. Muir-Torre syndrome
Quotation from the 9th edition of Lever's:
"Sebaceous adenomas are the most distinctive cutaneous markers of the Muir-Torre syndrome."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Because the neoplasms called "cystic sebaceous adenoma" are very well circumscribed and surrounded by compressed fibrous tissue, it may be inferred that those proliferations are longstanding and slow growing. Furthermore, that neoplasm has yet to be shown to metastasize. The morphologic findings of "cystic sebaceous adenoma," however, are those of a malignant neoplasm as assessed by criteria given earlier in this essay. After having reviewed many examples of these peculiar cystic neoplasms in three patients with either Muir-Torre syndrome or a family history of cancer in internal organs, it now seems reasonable to us to conclude that they represent cystic sebaceous carcinomas and not cystic sebaceous adenomas. Although we do not disclaim the possibility of these cystic neoplasms developing in patients who do not have, and will not develop, Muir-Torre syndrome, for the moment we regard them as indicative of that syndrome."
Nussen S, Ackerman AB. Sebaceous "adenoma" is sebaceous carcinoma.
Dermatopathology: Practical & Conceptual
4(1):5-14, 1998. (www.derm101.com)
Other works of ABA in which the ideas contrary are expressed:
1. Muir-Torre Syndrome (video), available at: www.derm101.com, 2005.
2. Ackerman AB, Lee SN. Neoplasms in all organs of Muir-Torre syndrome are carcinomas: sebaceous carcinomas and squamous-cell carcinomas (keratoacanthomas) in skin and adenocarcinomas, squamous-cell carcinomas, and transitional-cell carcinomas in internal organs.
Dermatopathology: Pratical & Conceptual
5(4):312-318, 1999.
3. Ackerman AB, Nussen S. Neoplasms in all organs of Muir-Torre syndrome are carcinomas.
Méd Biol Environn
26(2):139-141, 1998.
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