Book Review

Skin Cancer

N Engl J Med 1996; 335:827-828September 12, 1996

Article

Skin Cancer
Second edition. By Rona M. MacKie. 362 pp., illustrated. St. Louis, Mosby, 1996. $125. ISBN: 1-85317-203-0

Skin cancer is the number-one type of cancer in the United States, with over 1 million diagnoses expected in 1996. Management of this huge problem is complicated, because so many dermatologic conditions are dealt with by primary care physicians — only the complex disorders remain in the dermatologist's realm. Education about skin cancer is what Professor MacKie, an expert in the field, wishes to provide with this second edition of her 1989 book.

The book begins with an introduction to skin biology and histology and progresses to the causes, diagnosis, pathology, and treatment of melanoma and basal- and squamous-cell carcinomas. A chapter on genodermatoses discusses the extensive skin cancers associated with xeroderma pigmentosum, as well as genodermatoses not associated with cutaneous cancer, such as Gardner's syndrome, which is characterized by benign scalp cysts and colon cancer. Also covered are benign epidermal lesions and cysts, cutaneous lymphomas, skin-appendage tumors, cutaneous paraneoplastic manifestations of internal cancer, and prevention.

The strength of this work lies in its 435 color photographs (290 clinical images and 145 histopathological images). These high-quality images show classic presentations and alarming cases of advanced disease. We showed the book to more than a dozen of our colleagues — fellows, faculty members, and students. They were drawn in by the photographs, which take up more than half the book, giving the impression of a color atlas rather than a standard textbook. MacKie's text is crisp, clear, concise, and nonrepetitive. The major modifications of the first edition are the addition of new references and an expanded discussion of the prevention of skin cancer.

We did note some weaknesses. The references are inconveniently located in the back of the book, labeled only by chapter number (not title). Among the generally excellent clinical photographs, Figure 12.14, “clinical appearance of sebaceous gland hyperplasia on the nose,” shows a lesion that is uncharacteristic of this benign disorder and instead looks like a basal-cell carcinoma. Several of the histopathological photographs (Figure 12.3, 12.40, 12.45, and 13.47) are not in focus. Of the 32 photographs in the chapter on melanoma, only 2 are histologic images, as compared with at least half the 50 or so color photographs in the chapters on tumors of skin appendages and cutaneous lymphoma. This unevenness seems unwarranted, since each of these disorders has complex histopathological features.

Who would benefit most from buying this book? Without a doubt, the engaging photographs, their informative legends, and the organized, clear text will be helpful for any physician who examines the skin of patients. The author states her hope that the book will be useful to primary care physicians. We think this book occupies a niche somewhere between the standard textbooks for primary care physicians and those for dermatologists. For the generalist who must select a set of references covering conditions from cardiac disorders to infectious diseases, in addition to dermatologic disorders unrelated to cancer, the price of $125 for this book may represent a disproportionate investment. And the extensive histopathological component may not be too useful for the primary care physician. For comparison, although providing less detail on each topic and published in paperback, the second edition of the Color Atlas and Synopsis of Clinical Dermatology: Common and Serious Diseases, by Fitzpatrick et al. (New York: McGraw-Hill, 1994), covers the major topics of dermatology at 10 cents per photograph ($50 total), whereas Skin Cancer runs about 28 cents per photograph. A good option for the primary care physician would be the third edition of Thomas Habif's Clinical Dermatology: A Color Guide to Diagnosis and Therapy (St. Louis: Mosby, 1996). At the same price as Skin Cancer and with nearly 1000 excellent photographs, this book covers what the generalist needs to recognize in cutaneous cancer, as well as the other topics in dermatology.

The library of almost any dermatologist would be enhanced by this fine set of photographs of neoplastic processes. However, the text does not cover the complex issues that come up after the diagnosis and that dermatologists must deal with. For example, while reviewing the book, we saw a patient with recurrent squamous-cell carcinoma that had metastasized from a nearby primary cutaneous site. We wondered what treatment approaches MacKie would recommend, but the topic is not addressed. Similarly, one of our colleagues in pediatric dermatology was pleased to see a photograph of multiple Spitz nevi on the face of a child but disappointed to find no discussion of the management of this challenging condition.

It is estimated that 6 to 22 percent of patients who visit primary care physicians have as their chief problem a dermatologic condition, and only 20 to 36 percent of patients with skin diseases are cared for by dermatologists. We hope this useful resource and others similar to it will be accessible to generalists as well as dermatologists. The true beneficiaries will be the many patients whose cutaneous neoplasms are halted at an early stage.

Paul Nghiem, M.D., Ph.D.
Harley A. Haynes, M.D.
Harvard Medical School, Boston, MA 02115