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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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11. Follicular mucinosis/alopecia mucinosa
Quotation from the 9th edition of Lever's:
"Follicular mucinosis is characterized clinically by grouped erythematous papules and/or plaques that may be markedly indurated or nodular, and histologically by mucin accumulation in hair follicles. It is now classified in two types: a primary (idiopathic) type and a secondary variety. The primary form [of follicular mucinosis] tends to have a shorter but benign course. The secondary type has been associated with numerous benign and malignant conditions, including lymphomas, of which the majority are mycosis fungoides. A distinct variant of mycosis fungoides, follicular mycosis fungoides, may or may not be associated with follicular mucinosis."
"A long-term follow-up study (median 10 years) of seven patients aged less than 40 years with primary follicular mucinosis failed to demonstrate progression to cutaneous T-cell lymphoma, despite the presence of a T-cell clone in five of the patients."
"In 1957, Pinkus described alopecia mucinosa, the term used when follicular mucinosis affects terminal hair-bearing areas and is associated with hair loss."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Error: Follicular mucinosis is synonymous with alopecia mucinosa. Reason: Follicular mucinosis, in actuality, is epithelial mucinosis (infundibular epidermis and sebaceous lobules are affected more often than is the follicle itself) and it is completely different conceptually from alopecia mucinosa which, in reality, is mycosis fungoides, a systemic lymphoma that involves the skin most evidently. Epithelial mucinosis is an aberration of epithelium analogous to epidermolytic hyperkeratosis, focal acantholytic dyskeratosis, cornoid lamellation, and pale-cell acanthosis, to wit, a distinctive problem pathologic."
Ackerman AB, Böer A, Bennin B, Gottlieb GJ.
Histologic Diagnosis of Inflammatory Skin Diseases,
3rd Edition. New York: Ardor Scribendi, 2005.
Other works of ABA in which the ideas contrary are expressed:
1. Böer A, Ackerman AB.
Alopecia Mucinosa is Mycosis Fungoides.
New York: Ardor Scribendi, 2005.
2. Böer A, Guo Y, Ackerman AB. Alopecia mucinosa is mycosis fungoides.
Am J Dermatopathol
26(1):33-52, (February) 2004.
3. Hempstead RW, Ackerman AB. Follicular mucinosis: a reaction pattern in follicular epithelium.
Am J Dermatopathol
7:245-257 (June) 1985.
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