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Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
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Library of Congress Cataloging-in-Publication Data
Dermatopathology / edited by Klaus J. Busam. – 1st ed.
p. ; cm. – ( Foundations in diagnostic pathology)
Includes bibliographical references.
ISBN 978-0-443-06654-2
1. Skin–Diseases. 2. Skin–Cancer. I. Busam, Klaus J. II. Title. III. Series: Foundations in diagnostic
pathology.
[DNLM: 1. Skin Diseases–pathology. 2. Skin Neoplasms–pathology. WR 140 D4351705 2010]
RL96.D478 2010
616.5¢07–dc22
2009010247
Publishing Director: William R. Schmitt
Developmental Editor: Christine Abshire
Publishing Services Manager: Anitha Raj
Project Manager: Sruthi Viswam
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number
9 8
7
6
5
4
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1
This book is dedicated to my wife and children.
To Vinita—for your tireless love and support.
You put up with a lot!
To Jonathan and Sophia—for the joy of your company.
Foreword
The study and practice of anatomic pathology are both
exciting and overwhelming. Surgical pathology, with all
of the subspecialties it encompasses, and cytopathology
have become increasingly complex and sophisticated,
and it is not possible for any individual to master the
skills and knowledge required to perform all of these
tasks at the highest level. Simply being able to make a
correct diagnosis is challenging enough, but the standard
of care has far surpassed merely providing a diagnosis.
Pathologists are now asked to provide large amounts
of ancillary information, both diagnostic and prognos-
tic, often on small amounts of tissue, a task that can be
daunting even to the most experienced pathologist.
Although large general surgical pathology textbooks
are useful resources, they by necessity could not possibly
cover many of the aspects that pathologists need to know
and include in their reports. Accordingly, the concept
behind
Foundations in Diagnostic Pathology
was born.
This series is designed to cover the major areas of surgi-
cal pathology and cytopathology, and each edition in the
series is focused on one major topic. The goal of every
book in this series is to provide the essential information
that any pathologist, whether general or subspecialized,
in training or in practice, will find useful in the evalua-
tion of virtually any type of specimen encountered.
Dr. Klaus Busam, a world-renowned dermatopathol-
ogist at Memorial Sloan-Kettering Cancer Center, has
edited a superb state-of-the-art book covering the essen-
tial aspects of dermatopathology. This book is geared
not only to dermatopathologists or those who have a
particular interest in this topic, but also to general sur-
gical pathologists who encounter skin specimens as
part of their daily practice. The list of contributors is
impressive, including many authors who have contrib-
uted significantly to the dermatopathology literature.
More important, however, the authors are all practic-
ing dermatopathologists with an enormous collective
experience in the field.
As with all of the other editions in the
Foundations
in Diagnostic Pathology
series, the information in the
current text is presented in a uniform and organized
fashion, covering the essential clinical and pathologic
features of each entity, accompanied by a large number
of practical tables and high-quality photomicrographs.
Dermatopathology in particular lends itself to an algo-
rithmic approach to diagnosis, on which this book
consistently capitalizes. When applicable, the authors
integrate modern ancillary diagnostic techniques, includ-
ing immunohistochemistry, immunofluorescence, elec-
tron microscopy, and molecular diagnostics.
The book is organized into four major sections,
including histology of the skin, non-neoplastic derma-
tologic disorders, and, of course, tumors and pseudotu-
mors of the skin and subcutis. The final unique section
summarizes the salient features of the pathologic evalu-
ation of sections derived from Mohs surgery.
I wish to extend my heartfelt appreciation to Dr. Busam,
who took on this project despite innumerable other
professional and personal responsibilities. As usual he
provided enormous energy and wisdom in completing
this endeavor. I would also like to extend my sincere
appreciation to the many authors who have taken the
time from their busy lives to provide their expertise.
It is my hope you find this volume of
Foundations in
Diagnostic Pathology
to be a valuable help in your daily
practice of dermatopathology.
J
ohn
R. G
oldblum
, md
vii
Preface
When I was first approached with the idea of editing
this book, I hesitated, wondering whether it was worth
publishing another textbook on dermatopathology, a
field with a number of excellent books already avail-
able, including comprehensive reference texts as well as
basic introductions. On the other hand, pathology and
dermatology residents have been telling me that they
miss a textbook that covers more than the very basics,
but avoids an exhaustive attempt to review all that is
known in the field, and is compact enough so that they
can read it from start to finish during their residency
training. Such an introductory to midlevel book is what
the
Foundation in Diagnostic Pathology
series attempts
to provide. We wanted to offer a no-nonsense practical
book with emphasis on the clinical and histologic fea-
tures required to make a diagnosis. In an effort to keep
the book compact, compromises were necessary. A num-
ber of clinical issues or disease entities had to be left out
or could be mentioned only briefly. This affected in par-
ticular rare congenital diseases and entities for which
a skin biopsy provides only limited diagnostic value.
References were cut to a minimum, offering mainly
review articles or specialized books for the reader will-
ing to engage in a more in-depth exploration of a subject.
Minimizing references to save space for text and illustra-
tions seemed justifiable in an era when ready access to
the Internet permits quick retrieval of specialized arti-
cles and new publications are added to the literature at
a rapid pace. Controversial issues could not be discussed
in detail, but we tried to offer a balanced view and prac-
tical guide to deal with ambiguity and complexity.
As editor I would like to thank all the contributors
who made this book possible. It is the result of team-
work. I would also like to thank many individuals at
Memorial Sloan-Kettering Cancer Center who provided
direct or indirect help for this book, including Jennifer
Nobrega, Jason Bini, Allyne Manzo, Kin Kong, and
Drs. Melissa Pulitzer, Ruby Delgado, and Bijal Amin.
I am also grateful to Dr. Marc Rosenblum, Chair of Patho-
logy, and Dr. Allan Halpern, Chief of Dermatology, for a
supportive professional environment. Special thanks
go to members of the Dermatology Service for providing
clinical images and/or valuable comments, in particular
Drs. Kishwer Nehal, Patricia Myskowski, and Ashfaq
Marghoob. Finally I want to express my great apprecia-
tion for the support and patience I received from the
publisher, especially the help from William Schmitt,
Christine Abshire, and Sruthi Viswam.
ix

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