Ackerman AB Guo Y Lazova R Kaddu S:

2nd Edition, 220 pp, Ardor Scribendi, Ltd., 2001 ($150.00).

This volume follows the format of other volumes in Dr. Ackerman's series Differential Diagnosis in Dermatopathology. Two entities comprising a differential diagnostic problem are compared side by side with clinical and histologic photographs with an accompanying list of helpful diagnostic features. The visual presentation and list is followed by a more thorough discussion. This format can be an effective means to learning subtle clues in the diagnosis of dermatopathologic entities. In that regard, this volume can be helpful in the daily practice of pathologists and dermatopathologists as well as residents in training. The addition of comparative clinical images can be especially helpful for those coming from a pathology background. There are inherent limitations in this approach in that the differential diagnosis in a given case is often broader than a single pair of entities. Overall, however, this remains an effective means to clarify the differential diagnosis in selected entities.

According to the preface, one of the primary purposes of the second edition of this book reflects Dr. Ackerman's wish to rework the original text to “wrest mistakes from it, and to inject new concepts into it.” One of the principal mistakes Dr. Ackerman wished to correct is the quality of the clinical and histologic photographs. The improvement is especially noted in the photomicrographs, where the color balance is improved as compared with the previous edition. The difference in the clinical photographs is less striking.

The current edition includes new chapters on acute discoid lupus erythematosus versus subacute cutaneous lupus erythematosus, interstitial granuloma annulare versus interstitial mycosis fungoides, and mammary versus extramammary Paget's disease. The first of these three artfully points out the lack of significant histologic differences in cutaneous lupus erythematosus. The chapter on interstitial granuloma annulare is useful and offers a helpful approach in dealing with that differential question. The new chapter on Paget's disease, by contrast, is less helpful by its emphasis on differentiating mammary Paget's disease from extramammary Paget's disease. The more problematic situation is differentiating primary anogenital extramammary Paget's disease from secondary intraepidermal involvement from an underlying visceral malignancy. This is given little discussion in the text. A minor criticism is the lack of page numbers in the table of contents.

In summary, the Differential Diagnosis in Dermatopathology series by Dr. Ackerman remains an effective means of learning subtle histologic clues for difficult problems in dermatopathology. The images in the 2nd edition of the second volume are of higher quality than its predecessor and some of the text discussion is updated. However, the improvements in the second edition are not revolutionary in scope. As a stand-alone replacement for the current second volume in the series, the second edition is modestly successful. If the entire series is subsequently revised, this new volume would serve as a welcome addition to many bookshelves. Therefore, the decision to buy this book probably should be made in part on how well one likes the format of the series and how dissatisfied one was with the original second volume in comparison with the others in the series.