Ackerman AB Reddy VB Soyer HP:

Neoplasms with Follicular Differentiation, Second Edition, 1109 pp, New York, Ardor Scribendi Publishers, 2000 ($225.00).

The second edition of Neoplasms with Follicular Differentiation is everything one would expect from Dr. Bernard Ackerman. Beautifully written and illustrated, intellectually challenging, controversial, and encyclopedic in both breadth of coverage and size, the second edition has more than 200 new photographs with increased emphasis on trichoblastoma and “trichoblastic carcinoma.” Dr. Ackerman contends the nature and accurate diagnosis of follicular neoplasms has long been obscured by incomprehensible terminology and illogical classification. I heartily agree, and his attempt to shed light on this perplexing topic is most welcome.

Dr. Ackerman proposes a new classification of follicular proliferations based on his method of pattern analysis and carefully defined categories of cyst, malformation, hamartomas, hyperplasias, benign neoplasms, and malignant neoplasms. Proliferations are deemed follicular in nature if they show microscopic evidence of differentiation toward elements of the follicle. This contrasts with classifications based on evidence of origin from follicular elements. This method certainly holds great appeal for those of us outside academe’s ivory towers with only our trusty microscopes to guide us, but will no doubt rankle those who feel it would be more scientifically honest to define follicular proliferations based on origin from primordial “follicle” cells.

Many of the proliferations discussed are well-accepted entities such as nevus comedonicus (malformation), fibrous papule (hamartoma), and tricholemmoma (hyperplasia). In addition to reviewing historical, clinical, and histopathologic aspects, Dr. Ackerman manages to embellish even these less controversial entities with wisdom gleaned from his own extensive experience. For example, he notes that, in his opinion, perifollicular fibroma is simply a form of fibrous papule; similarly, most tricholemmomas and inverting follicular keratoses are described as forms of verruca vulgares.

More than half of the book is devoted to his concept of trichoblastoma and trichoblastic carcinoma. Dr. Ackerman encompasses trichoepithelioma, desmoplastic trichoepithelioma, adamantoid trichoblastoma, trichoblastic fibroma, and prototypical trichoblastoma as variants of trichoblastoma. Trichoblastic carcinoma represents its malignant counterpart, based on classic Ackerman criteria of malignancy: asymmetry, poor circumscription, etc. In addition, Ackerman considers basal cell carcinoma to be trichoblastic carcinoma.

Neoplasms with Follicular Differentiation will not appeal to everyone. Dr. Ackerman stakes out positions that are diametrically different from many other experts in dermatopathology. Controversial opinions are stated with the certainty of fact, for example: “solar keratoses are squamous cell carcinomas.” Nevertheless, I greatly enjoyed this book and would unabashedly recommend it to readers with a particular interest in dermatopathology. Dr. Ackerman presents a novel view of follicular proliferations in a wonderfully lucid, logical fashion, backing up his claims with extensive black and white and color photographs that are uniformly excellent. The text is in his own imitable style with his usual clarity and flourish. However, this is a book perhaps most appropriate for those with a fairly solid background in dermatopathology who will best appreciate and evaluate the differences between Dr. Ackerman’s classification and those of others in the field.