Practical Immunopathology of the Skin

Dr Smoller has accomplished a concise book that contains much of the current knowledge on practical immunohistochemistry applied to skin pathology.

The book is organized in an introduction, a directory of antibodies, and a series of vignettes. The introduction has a short overview on how and when immunohistochemistry should be performed. Dr Smoller indicates some very important points in this overview, eg, the need of supervision by a qualified physician such as a surgical pathologist or a dermatopathologist. Interpretation of immunohistochemical slides requires correlation with external and internal controls, and with clinical information. Dr Smoller stresses the fact that immunohistochemistry by itself cannot establish a diagnosis of malignancy or benignity in a specimen. The introduction also contains a very informative description of immunohistochemistry that includes methodology and a discussion of possible pitfalls in the interpretation of immunohistochemical slides, such as the distinction of cytoplasmic vs nuclear expression depending on the particular antibody.

The second part of the book is a list of antibodies. Dr Smoller has chosen a classification based on the use of the antibodies rather than the more classic manner of dividing them in morphologic groups (keratins, intermediate filaments, differentiation markers, etc). This organization makes the book easier to be read by a diagnostician trying to evaluate a particular specimen.

The final section of the book includes 11 demonstrative cases to illustrate how Dr Smoller uses immunohistochemistry as an aid in the differential diagnosis of several of the commonest lesions of the skin. Each vignette includes a short description of the clinical and histologic features of the cases, followed by the immunohistochemical findings, and a table with the expected results in each of the possible diagnoses.

The book has just a few points that might have been improved. It is unfortunate that many of the pictures are black and white, since color is such an important component in the interpretation of immunohistochemical slides. Some of the tables may be difficult to interpret since the last entries do not list the percentage of positivity; although it seems that the author means for those entities to have a lesser percentage of positivity than the listed ones, they could have been listed as approximately 0%. Although the author probably wanted to limit the size of the book, the vignettes could have been expanded to detail more precisely the diagnosis. Additionally, there are 2 minor points that can be added to the excellent description of antibodies: First, chromogranin A can be expressed in basal cell carcinomas so basal cell carcinoma should be considered in the differential diagnosis of basaloid tumors expressing this marker. Second, the thyroid transcription factor 1 has a nuclear pattern of expression.

In summary, this book is an excellent glossary of methods and application of immunohistochemistry to skin pathology and should be included in the library of pathologists and dermatopathologists interested in how immunohistochemistry is applied to help in the diagnosis of skin lesions.

Utility Index: Important

Production Quality: Excellent

Primary Readership: Clinical dermatologists, subspecialists in dermatology (dermatopathologists)

Value for Money: Good buy