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Dermatopathology: Practical & Conceptual January - March 2006
>
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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16. Dermatofibroma
Quotation from the 9th edition of Lever's:
"Benign fibrous histiocytoma (BFH) has also been known as dermatofibroma, histiocytoma, and sclerosing hemangioma. These common tumors occur usually on the extremities of young adults"
"Neoplasm versus Reactive Process—The view has been expressed that BFH are not true neoplasms but reactive fibroblastic proliferation subsequent to trauma, including arthropod bites. These tumors have been referred to as 'nodular subepidermal fibrosis," and are regarded by some authorities as fibrosing inflammatory lesions, even in the presence of 'monster cells." The demonstration of clonality in some cases of dermatofibroma and reports of metastasizing cellular dermatofibroma suggest a neoplastic nature."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"A dermatofibroma results from trauma to the skin, the dermis in particular, but sometimes the subcutaneous fat, too. The most common of those traumas are assaults by arthropods, punctures of other kinds, and rupture of follicles and of cysts, usually infundibular ones. In brief, such traumas induce an inflammatory response that can be divided into three stages that overlap: granulation tissue accompanied often by hemorrhage, granulomatous inflammation, and fibrosis."
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. Ackerman AB. Chongchitnant N, Sanchez J, Guo Y.
Histologic Diagnosis of Inflammatory Skin Diseases
. 2nd edition. Baltimore: Lippincott Williams & Wilkins, 1997.
2. Ackerman AB, Couch AP, Crum CP, Scully RE. Reactive (changes, histiocytes, hyperplasia, fibroplasia, proliferation, atypia, etc.)?
Dermatopathology: Practical & Conceptual
3(4):348-354, 1997.
3. Ackerman AB, Cavegn BM, Casintahan MF, Robinson MJ.
Resolving Quandaries in Dermatology, Pathology and Dermatopathology.
Vol 1 pp 75 Promethean Medical Press/Waverly, 1995.
4. Ackerman AB, Ragaz A.
The Lives of Lesions: Chronology in Dermatopathology.
pp 37. Masson Publishing USA, Inc., 1984. (Now on the list of Ardor Scribendi, NYC)
5. Ackerman AB.
Histologic Diagnosis of Inflammatory Skin Diseases: A Method by Pattern Analysis.
Philadelphia: Lea and Febiger, 1978.
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