SW Menzies et al
Published by The McGraw-Hill Companies Inc (2003)
ISBN: 0-0747-1102-4. 171 pages plus index.
This atlas is an expert review of surface microscopy of pigmented skin lesions, designed to be of use to the novice as well as those experienced in regularly examining the skin. The second edition has been substantially rewritten and expanded from the first edition (published in 1996). It comes with a CD-ROM containing a quiz of 217 lesions. It is set out into eight chapters, each of which begins with a succinct description of the important features in the chapter. The greatest strength of the atlas is the clinical and histopathological correlation with the dermatoscopic features. All but three benign lesions in the book were biopsied and reviewed for histological diagnosis. The clarity of the photographs throughout the book are excellent, as are the images on the CD attached to the atlas.
As well as comprehensively defining the important individual diagnostic features used in surface microscopy, Menzies et al describe a (two-step) surface microscopy method for the diagnosis of pigmented skin lesions, which the newcomer to surface microscopy will find very useful. Initially the lesion is identified as melanocytic or non-melanocytic. If the lesion is identified as melanocytic, then a second step procedure is used to differentiate between benign melanocytic lesions and melanoma. At least one of nine positive features must be found and both negative features (symmetrical pigmentation pattern and the presence of only a single colour) must be absent. Although there are a number of other diagnostic algorithms that can be used, this system is simple and easily learned. This algorithm can then be applied to identifying images on the CD-ROM. The ‘help’ page very clearly describes the method and how it is used to work through the quiz images. These can be looked at in random, diagnostic or features order, depending on the requirement of the user.
The last chapter briefly discusses the use of digital (computerised) surface microscopy systems. This is a very topical issue and perhaps could have been covered in more detail. Some may disagree with the idea of short-term monitoring of atypical or changing melanocytic lesions, but the authors do include strict criteria for excising such lesions over a three-month period.
Skin surface microscopy is a tool which has been shown to improve the diagnosis of pigmented lesions and this publication will be an invaluable aid to all those clinicians who are presented with skin lesions for diagnosis.