Book Review

An Illustrated Guide to Skin Lymphoma

N Engl J Med 1999; 341:62-63July 1, 1999

Article

An Illustrated Guide to Skin Lymphoma
By Lorenzo Cerroni, Helmut Kerl, and Kevin Gatter. 123 pp., illustrated. Boston, Blackwell Science, 1998. $199.95. ISBN: 0-632-05082-9

The classification of lymphomas has been a challenge to our intellect and to our science. Over the past 40 years, we have moved through numerous classification schemes, which have varied in usefulness. Some schemes were purely morphologic classifications with some clinical implications, such as those based on whether the tumor cells were small, medium, or large lymphocytes (e.g., the Rappaport classification). Others have been more clinically oriented and have encompassed a number of different morphologic types; for example, in the Working Formulation, lymphomas were grouped into low, intermediate, and high grades according to their clinical behavior. High-grade lymphomas included both small-noncleaved-cell lymphomas and large-cell, anaplastic lymphomas. Later, attempts were made to incorporate immunohistochemical and molecular genetic data into the classifications, such that T-cell and B-cell lymphomas were separated (e.g., the Lukes–Collins and Kiel classifications).

While the gurus of lymph-node pathology struggled with these classifications, many ignored lymphomas arising in the skin and relegated them to the “other” category. Now there is renewed interest in cutaneous lymphomas, primarily because of the recognition that they are not rare oddities but, rather, are common and potentially lethal disorders. Early studies that failed to separate T-cell and B-cell lymphomas pooled disparate entities on the basis of their clinical behavior: for instance, mycosis fungoides (a T-cell lymphoma presenting initially in the skin) was categorized with B-cell lymphomas, which can be primary or secondary in the skin. Such B-cell lymphomas are often discrete, purplish nodules in the skin and were misclassified as “mycosis fungoides d'emblée,” or mycosis fungoides arising as new tumors of the skin. With the introduction of modern immunohistochemistry and genetic techniques, these lymphomas have been distinguished, and a clearer classification has been based on specific disease “entities” in lymphoma. For instance, a single disease can start as a small-cell lymphoma and progress to a large-cell lymphoma. Examples of this approach to classification are the Revised European–American Lymphoma (REAL) and the European Organization for Research and Treatment of Cancer (EORTC) classifications, and now the World Health Organization (WHO) classification.

An Illustrated Guide to Skin Lymphoma arrives at just the right moment to help us apply these new classifications to skin lymphomas. The authors are recognized experts in this area and have produced an outstanding book. It will help experts and beginners to understand the clinical and histologic appearances of the lymphomas as they involve the skin. The book is valuable for its brevity (only about 120 pages), for the excellence of its illustrations, and for the lucidity of its text, which is kept as simple as possible. The authors restrict citations to the key 3 to 20 references, rather than trying to be encyclopedic. The text itself is augmented by the generous and skillful use of tables of data. The book is basically an atlas with some commentary on the entities, but it is a highly useful presentation. Almost all the illustrations are in full color and of astonishingly high quality. The technical aspects of the histologic preparations are nearly flawless, showing the devotion of the authors to high standards of both science and art.

In this book there is something for everyone to learn. Even though it was conceived during 1997 and published in 1998, the concepts remain appropriate and make it a valuable addition to one's library and to one's thoughts.

N. Scott McNutt, M.D.
Weill Medical College of Cornell University, New York, NY 10021