By Bruce R. Smoller
Dermatopathology: The Basics will function a good and effective guide for the scholar of dermatopathology, and as a realistic bench reference for the training diagnostician who wants speedy entry to standards which are valuable in differentiating histologically related entities. The chapters include crucial bullet issues prepared in prepared outlines taking into consideration easy accessibility and direct comparability among entities. the frilly pictorial documentation also will let the publication to function an atlas of the most typical dermatologic disorders.
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Extra info for Dermatopathology: The Basics
3 For small lesions, punch biopsies may allow adequate margin evaluation Melanocytic Neoplasms • Elliptical excisions are best for determining depth and margins of excision • A shave biopsy may not be deep enough to get beneath the dermal component for accurate assessment of Breslow thickness • A punch biopsy may not allow for evaluation of circumscription as a diagnostic feature Presumed Neoplastic Processes 41 Keratinocytic Neoplasms • A deep shave or punch biopsy is ideal, as a shave biopsy that is too shallow: – May not permit distinction of squamous cell carcinoma from squamatized basal cell carcinoma – Will not allow for precise subtyping of basal cell carcinoma variant (and likelihood of local recurrence) (Fig.
37 Nipple skin demonstrates papillomatosis, acanthosis, prominent sebaceous glands, abundant smooth muscle bundles, and glandular epithelium (×400) • Mucosa – Mucosa is NOT skin – important to recognize differences: ❜ ❜ ❜ ❜ ❜ ❜ Parakeratosis is normal in mucosa, and one does not see “basket-weave” orthokeratosis No granular layer is present (unless traumatized) Keratinocytes have abundant glycogenization (and appear very pale) No pilosebaceous units are present (except with anomalous Fordyce spots) Plasma cells are a normal part of inflammatory infiltrate in submucosa Salivary glands and ducts may be present Skin of “Special Sites” 35 Fig.
9 The large pleomorphic nuclei and numerous mitoses (A) indicating malignant transformation in this spiradenocarcinoma (B) may be missed in a partial sample 46 2 How to Maximize Information from a Skin Biopsy Fig. 10 Unlike the other examples, without the benefit of the overall architecture, a partial sampling that shows nuclear atypia and mitoses (A) may be mistaken as features of malignancy in this benign proliferating pilar cyst (B) Dermal Neoplasms • For tumors of mesenchymal etiology, a punch biopsy allows enough lesion to evaluate for tumor type • A deep biopsy to assess the deep margin, in particular the interaction of the tumor with the subcutaneous tissue is important (Fig.
Dermatopathology: The Basics by Bruce R. Smoller