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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.
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
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
28. Malignant blue nevus
Quotation from the 9th edition of Lever's:
"It may arise in a blue or cellular blue nevus, a giant congenital nevus, or in a nevus of Ota, or it may be malignant from the start."
"Recognition of the lesion as a malignant blue nevus rather than a common melanoma is based on the absence of junctional activity and the presence of at least some bipolar tumor cells with branching dendritic processes containing melanin granules."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Because the diagnoses "atypical blue nevus," "atypical cellular blue nevus," "metastasizing blue nevus" and "malignant blue nevus" have never been defined in a comprehensible, meaningful, repeatable way, they serve only to bewilder clinicians and, therefore, cannot be beneficial to patients. Most examples of "atypical blue nevus" and "atypical cellular blue nevus" reported on are not nevi at all, but are melanomas; they metastasized, some of them resulting in death.X The diagnoses "atypical blue nevus," "malignant blue nevus," and "metastasizing blue nevus" seem to denote, no matter how bizarrely, benignancy, the last word of each triplet being "nevus"; no nevus, including blue nevus, is malignant and none can metastasize. A nevus that metastasizes is a melanoma that was misdiagnosed originally. Moreover, the idea that "these lesions have the ability to metastasize to local lymph nodes but are not capable of widespread metastases" is distilled nonsense, contrary to logic, and an affront to rationality; a metastasis by definition, disseminates."
Mones JM, Ackerman AB. A critique in historical perspective of three concepts flawed fatally: "atypical" blue nevus, "malignant" blue nevus, and "metastasizing" blue nevus.
Dermatopathology: Practical & Conceptual
Other works of ABA in which the ideas contrary are expressed:
Ackerman AB, Cerroni L, Kerl H.
Pitfalls in Histopathologic Diagnosis of Malignant Melanoma
. Philadelphia: Lea & Febiger, 1994.
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