Book Review

Pathology of the Skin with Clinical Correlations

N Engl J Med 1996; 335:826-827September 12, 1996

Article

Pathology of the Skin with Clinical Correlations
Second edition. By Philip H. McKee. Approximately 850 pp., illustrated. St. Louis, Mosby, 1996. $325. ISBN: 1-56375-5882

Skin biopsies are as important to dermatologists as radiographs are to orthopedists and as electrocardiograms are to cardiologists. But students and primary care physicians are usually sheltered from dermatopathology. Many do not realize that training in dermatopathology makes up about one fourth of a dermatology residency, and questions on this topic constitute about a fourth of the specialty-board examination. A large portion of the examination for certification by the American Board of Dermatology consists of examining microscope slides and making diagnoses. In practice, the best dermatologists do not send their biopsy specimens to any laboratory — they examine the specimens themselves or send them to an expert, just as I, as a medical student, was asked by my attending internist to take a chest x-ray film to a wise pulmonologist for review, even though it had already been read by a radiologist.

It is therefore appropriate that this book is entitled Pathology of the Skin with Clinical Correlations. Pathologists and dermatologists must never look at histologic findings without duly considering the clinical presentations. This book is particularly good at showing the relation between the clinical lesions and the corresponding histologic findings. It is mainly an atlas of histopathology, with the majority of the more than 3000 gorgeous color photographs depicting sections of skin stained with hematoxylin and eosin. There are also many photographs of patients with skin lesions. Because the author has a strong background in general pathology, the book has more illustrations of relevant lesions of other organs than do most books of this type. A limited number of pertinent immunofluorescence, immunohistochemical, and electron-microscopical results are also presented.

The second edition has added descriptions of 100 new diseases, including AIDS-related disorders. The references are as current as anyone could expect to find in a textbook. There is a substantial amount of text accompanying the photographs. It is impressive that a single author has compiled this tome, with help from others in collecting the clinical illustrations, and consequently the writing style is uniform throughout. The accuracy of the book is superb.

Treatment is not discussed; the emphasis is on diagnosis. Differential diagnosis is considered, but that is not the strength of the book. The organization of the chapters is for the most part logical, but any classification of diseases is imperfect, since it is impossible to put all skin diseases into chapters on the basis of cause, pathologic morphology, or clinical features. If a book is based on morphology, then there is the question of what to do with diseases for which the morphology varies. If it is based on cause, then there is the problem of where to put idiopathic disorders. Consequently, this book has several incongruities, such as a hodgepodge chapter on inflammatory diseases and a huge chapter on tumors of the dermis and subcutaneous fat. Idiopathic guttate hypomelanosis is curiously placed in a chapter entitled “Melanocytic Naevi and Malignant Melanoma.”

The book will be purchased mainly by dermatologists and pathologists. Primary care physicians will prefer one of the many atlases that show only clinical lesions, without the corresponding histologic findings. They will not know what they are missing. This magnificent work is one of the best-illustrated books available that covers the gamut of dermatopathology.

Ronald P. Rapini, M.D.
Texas Tech University, Lubbock, TX 79430