Lever’s Histopathology of the Skin 10th Edition PDF
130.12 MB PDF
This book represents an incremental revision and update of the previous two editions, the first of which constituted a somewhat more extensive revision of the seven editions produced by Walter Lever, MD, beginning in 1949 as a 449-page volume with “221 Illustrations Including 8 Subjects in Color on 4 Plates.” Thus, this will be the tenth edition of a book that has been continuously published for 60 years! In this second generation of the work, the principles that made “Lever” such a success for so long continue to be applied. These include, first and foremost, a continued organization of the book along the lines of a traditional clinicopathologic classification of cutaneous disease. This enables us to discuss lesions according to their clinical and etiological relationships, paralleling the organization of the major clinical texts. In some other dermatopathology works, a greater emphasis has been placed on histological patterns of disease as the underpinning of the chapter organization. This has advantages in enabling beginners to develop an appropriate differential diagnosis for a given pattern of disease, but can be confusing in that etiologically and clinically disparate conditions tend to be discussed in juxtaposition to each other, and also in that polymorphous conditions need to be discussed in multiple different places.
We have taken into account the modern emphasis on pattern recognition in several ways. First, within each chapter, the conditions considered are, when appropriate, organized and discussed along pattern lines. Second, we have, as in the past, included a chapter that presents an algorithmic classification of skin diseases according to histologic pattern features. It is intended that this chapter may serve as a means of developing a differential diagnosis from an unknown slide, following which references are provided for discussion of the disorders in other areas of the book. In addition, we have prepared a companion volume “Atlas and Synopsis of Lever’s Histopathology of the Skin,” now in its second edition. This Atlas has enabled us to greatly extend the number of illustrations including a larger number of clinical images, and is organized completely on the basis of histologic patterns. Unlike some other pattern-based works, this Atlas includes neoplastic disorders among the inflammatory conditions. Thus, it becomes clear to the reader that a lichenoid actinic keratosis or in situ melanoma may share features with (and potentially be misdiagnosed as) a plaque of lichen planus or a patch of lupus. This Atlas, which was produced as a companion to the last edition of the “Big Lever,” will be continue to be updated and extended to incorporate the new information in successive editions of “Lever.”
In another area of emphasis, we have continued the practice of providing clinical review prior to exposition of the histologic features for each group of disorders. This, in our opinion, greatly enhances the value of the work, not only for pathologists and others whose primary training is not in clinical dermatology, but also for dermatologists in training and, no doubt, for some who are more advanced in the field as well. In this present edition, we have included clinical images to enhance this distinctive aspect of the text, recognizing that the clinical morphology is the “gross pathology” of dermatopathology. Indeed, in today’s environment of ubiquitous digital cameras and internet connections, we would take this opportunity to encourage clinicians to submit with their biopsies not only detailed clinical differentials, but also clinical images of selected cases, for the benefit of more accurate diagnosis and improved patient care.
At the other end of the spectrum of clinical science, we have continued and updated the classic work’s emphasis on “histogenesis” by emphasizing underlying mechanisms of disease. To us, the term histogenesis includes mechanisms of development of histological patterns of disease and might equally well be (and sometime is) labeled “pathogenesis.” In this edition, more than in any other because of the explosion of knowledge, molecular mechanisms of pathogenesis are presented for perhaps almost a majority of the diseases. However, it is interesting that, in most cases, these molecular mechanisms, while of explanatory interest, have not yet supplanted traditional histopathology and immunohistology as the “gold standard” for diagnosis of most of the conditions discussed in the book.
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