BOOK REVIEWS
book reviews
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Ackerman AB, Chongchitnant N, Sanchez J, Guo Y, clinical and histopathologic terminology and so is useful to
Bennin B, Reichel M, Randall MB. Histologic Diagnosis of all readers.
Inflammatory Skin Diseases. An Algorithmic Method Part II, Proceeding to the Specific Diagnosis, explains
Based on Pattern Analysis. 2nd edition. Baltimore: the pattern analysis method and the basic patterns. Some
Williams and Wilkins, 1997, 942 pp, $259.00. illustrations about the use of pattern analysis will be familiar
to readers of the first volume. Streamlined algorithms are
Histologic Diagnosis of Inflammatory Skin Diseases. An presented, and there are illustrations of all the variations and
Algorithmic Method Based on Pattern Analysis is the long- combinations within each of the 9 basic patterns. A
awaited second edition of a classic text published as a single- discussion of the use of algorithms follows with the
authored text in 1978. Dr Ackerman stresses that this book is limitations of the method, followed by the complete set of
a new work in many important ways. While he is certainly algorithms for each category. Because of "the proclivity of
correct, the familiar aspects of this work make it instantly the same cutaneous inflammatory disease to express itself
accessible and essential to any practitioner for whom the differently histopathologically at different times in its
diagnosis of inflammatory dermatoses is a daily task. The chronological course," an individual disease may be found in
book is based on pattern analysis of inflammatory disease, more than 1 algorithm, but all the detailed information about
and the 9 basic patterns presented in the first edition are that disease is found under its specific listing in Part III, a
utilized here. A major addition is the use of detailed distinct improvement over the first edition.
diagnostic algorithms within each basic pattern which allow Part III contains detailed discussions of approximately
the reader to arrive at a specific diagnosis or small group of 125 specific diagnoses, including single disease entities and
diagnoses. The reader may then refer to a separate detailed groups of histopathologic "look-alikes." These are arranged
discussion of a specific diagnosis for more and confirmatory alphabetically to allow easy location after use of the algo-
information. The addition of algorithms allows organization rithm identifies one as a possible diagnosis. The discussion
of a confusing topic and determination of a specific of the individual disease is complete, containing clinical
diagnosis, giving a systematic and reliable approach to the aspects, clinical correlations, clinical differential diagnosis,
diagnosis of cutaneous inflammatory disease. histopathologic findings, variations, and differential
The book is organized into 4 parts, each essential to the diagnosis. The histopathologic features of the disease in
application of pattern analysis. Part I, Preparing for a early, fully developed, and late stages are detailed, a very
Specific Diagnosis, contains a review of cutaneous helpful feature. Clues to the specific diagnosis are presented,
embryology, structure, and function. All of the structural followed by a section on laboratory confirmation methods
units of the skin and appendageal structures are present. The and a discussion of pathophysiology. Each segment contains
drawings, photomicrographs (black and white), and electron a comment which elaborates on the information presented
micrographs are of excellent quality and are very useful. and draws on the broad experience that Dr Ackerman and his
Most dermatopathology texts contain drawings of the hair colleagues bring to dermatopathology. A detailed biblio-
follicle during the phases of the hair cycle rather than graphy is present for each entity, often including the original
photomicrographs, making identification of the phases citation of the condition. The written material is followed by
difficult. This text has helpful photomicrographs of follicles color photomicrographs presented in an algorithm fashion.
in different phases, illustrating that these concepts are more There is a low-power image to demonstrate the pattern and
than hypothetical. Chapters on biopsy technique, then 1 or more higher magnification views which
terminology, and inflammatory cells are also included in this demonstrate specific findings leading to diagnosis. The
section. The chapter on terminology encompasses both photomicrographs are uniformly excellent. There is also a
© American Society of Clinical Pathologists Am J Clin Pathol 1999;112:271-272 271
BOOK REVIEWS
chapter on diseases which simulate inflammatory disorders; the rest of the book, but I urge practitioners to read this book
neoplasms such as mycosis fungoides and diseases like cover to cover before using it at the microscope.
porphyia and amyloidosis. The opinions of the authors are present (Appendix:
Part IV, Coming to a Specific Diagnosis by Another Erroneous Concepts of Inflammatory Skin Diseases and
Route, is an expanded and improved version of the When Simulators of Them) and may differ from other published
You See—Think! section of the first edition. Photomicro- sources, but it is a challenge for the reader to reconcile
graphs of nonspecific but significant findings are presented, outstanding issues. The nearly 20-year wait between the first
along with additional features that lead to a specific and second editions has afforded Dr Ackerman and his
diagnosis. The nonspecific findings are ones that may be colleagues a vast accumulation of experience, a continual
appreciated at higher magnification, and algorithms in this refinement of the pattern method, and a mature and confident
section work backwards, adding low-power features to a expression of years of study and thought about cutaneous
nonspecific but significant finding to arrive at a diagnosis. disease.
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This book is essential for dermatologists, dermato-
pathologists, and pathologists. The text is well written and Ellen B. Rest, MD
immensely informative. It is user-friendly and can be used Department of Dermatology
immediately by those familiar with pattern analysis and the University of Minnesota Medical School
first volume. It is tempting to use the algorithms in Part II Minneapolis, MN
and discussions of specific entities in Part III without reading
Maize JC, Burgdorf WHC, Hurt MA, LeBoit PE, in these chapters. The clinical pathologic correlations
Metcalf JS, Smith T, Solomon AR. Cutaneous Pathology. provide information about different stages of disease and the
Philadelphia: Churchill Livingstone, 1998, 818 pp, histologic alterations that can be expected.
$129.00. The chapter on alopecia emphasizes the use of transverse
sectioning for diagnosis and includes photomicrographs of
The authors of Cutaneous Pathology have achieved such sections. There is a helpful discussion of the hair cycle
their stated goal of providing a concise and easy-to-use guide and useful photomicrographs demonstrating how to interpret
to the diagnosis of skin disease. This general text covers transverse sections. The discussion of the diagnosis of
inflammatory, neoplastic, developmental, and noninflam- alopecia is based on transverse section histopathology.
matory disorders. The discussion of most entities includes Chapters on melanocytic neoplasms and cutaneous
sections on clinical features, histopathologic features, lymphoproliferative disorders are appropriately
clinical pathologic correlation, differential diagnosis, and longer and more detailed.
pathophysiology. Algorithms and tables are used in most I highly recommend this book for dermatology and
sections and are very helpful. Most commonly encountered pathology residents and for practitioners needing a concise
diseases are discussed, but some more unusual entities are general text. All chapters have extensive bibliographies
mentioned briefly or are missing. The photomicrographs are offering up-to-date citations for further information. This text
in black and white and are generally good, but some low- is an easy to use, well-written guide for every day use.
power shots are out of focus.
The sections on inflammatory disease are arranged by Ellen B. Rest, MD
pattern diagnosis with a discussion of reaction patterns. Department of Dermatology
Algorithms are used within major categories, a feature University of Minnesota
helpful for an "at the microscope" guide. The authors have Minneapolis, MN
used some of the "clues" popularized by Dr A. B. Ackerman
272 AmJCIinPathol 1999;112:271-272 © American Society of Clinical Pathologists
