Searchable Full Expert CONSULT Activate at expertconsult.com Text Online 9 |FOURTH EDITION VOLUME ONE MCKEE’S PATHOLOGY SKIN of the l WITH CLINICAL CORRELATIONS imSk mxV m i fw&A.<:e>gSM v Wiik Kt. 7ÿ:.O'"1;(cid:127) v'i* tm m . * « 7* f7 >(cid:127)» r.T 7 (cid:127) r<*/ B (7 A > Ajx A 7 I t f EDUARDO CALONJE (cid:127)THOMAS BRF.NN ALEXANDER LAZAR* PHILLIP H MCKEE SAUNDERS ELSEVIER M K c ee’s Pathology Skin of the Commissioning Editor: William R. Schmitt Development Editors: Louise Cook & Rachael Harrison Editorial Assistant: Kirsten Lowson Project Manager: Nancy Arnott Design: Kirsteen Wright Illustration Manager: Merlyn Harvey Marketing Manager (USA): Tracie Pasker IFourth Edition M K c ee’s Pathology Skin of the I with Clinical Correlations Volume 1 Eduardo Calonje Alexander Lazar MD, DipRCPath MD, PhD Director of Dermatopathology Associate Professor Department of Dermatopathology Departments of Pathology and Dermatology St John's Institute of Dermatology Sections of Dermatopathology and Sarcoma Pathology St Thomas' Hospital Faculty, Sarcoma Research Center and Graduate School London, UK of Biomedical Science The University of Texas M.D. Anderson Cancer Center Thomas Brenn MD, PhD, FRCPath Houston, Texas, USA Consultant Dermatopathologist and Honorary Senior Editor-in-Chief Lecturer Department of Pathology Phillip H McKee MD, FRCPath Western General Hospital and The University Formerly Associate Professor of Pathology and of Edinburgh Director, Division of Dermatopathology Edinburgh, UK Department of Surgical Pathology Brigham and Women's Hospital and Harvard Medical School Boston, MA, USA For additional online references and video content visit expertconsult.com LSEVIERI ELSEVIER SAUNDERS SAUNDERS an imprint of Elsevier Limited © 2012, Elsevier Limited All rights reserved. First edition 1989 Second edition 1996 Third edition 2005 Fourth edition 2012 The right of Eduardo Calonje, Thomas Brenn, Alexander Lazar and Phillip H McKee to be identified as author of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. British Library Cataloguing in Publication Data McKee's Pathology of the Skin. – 4th ed. 1. Skin–Diseases. 2. Skin–Histopathology. I. Pathology of the skin II. Calonje, Eduardo. III. McKee, Phillip H. Pathology of the skin. 616.5'07-dc22 ISBN-13: 978 1 4160 5649 2 Working together to grow libraries in developingcountries www.elsevier.com | www.bookaid.org | www.sabre.org ELSEVIER BOOKAID SabreFoundation International Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contents List of Contributors vii Preface to the fourth edition x Acknowledgements xi Dedications xii Glossary xiii Volume 1 1 The structure and function of skin 1 11 Diseases of the oral mucosa 362 John A. McGrath Sook-Bin Woo 2 Specialized techniques in dermatopathology 32 12 Diseases of the anogenital skin 437 Pratistadevi A. Ramdial, Boris C. Bastian, John Goodlad, Eduardo Calonje, Sallie Neill, Chris Bunker, John K. McGrath and Alexander Lazar Nick Francis, Alcides Chaux and Antonio C Cubilla 3 Disorders of keratinization 46 13 Degenerative and metabolic diseases 520 Dieter Metze Nooshin Brinster and Eduardo Calonje 4 Inherited and autoimmune subepidermal blistering 14 Cutaneous adverse reactions to drugs 590 diseases 99 Nooshin Brinster 5 Acantholytic disorders 151 15 Neutrophilic and eosinophilic 6 Spongiotic, psoriasiform and pustular dermatoses 631 dermatoses 180 16 Vascular diseases 658 7 Lichenoid and interface dermatitis 219 17 Idiopathic connective tissue Wei-Lien Wang and Alexander Lazar disorders 711 Bostjan Luzar and Eduardo Calonje 8 Superficial and deep perivascular inflammatory dermatoses 259 18 Infectious diseases of the skin 760 9 Granulomatous, necrobiotic and perforating Wayne Grayson dermatoses 281 10 Inflammatory diseases of the subcutaneous fat 326 Bostjan Luzar and Eduardo Calonje Volume 2 19 Human immunodeficiency virus (HIV) 22 Diseases of the hair 967 and acquired immunodeficiency Rodrigo Restrepo and Eduardo Calonje syndrome (AIDS)-associated cutaneous diseases 896 23 Diseases of the nails 1051 Pratistadevi K. Ramdial and Wayne Grayson Josette Andre, Ursula Sass and Anne Theunis 20 Disorders of pigmentation 912 24 Tumors of the surface epithelium 1076 21 Diseases of collagen and elastic tissue 935 25 Melanocytic nevi 1150 Wei-Lien Wang and Alexander Lazar Bostjan Luzar, Boris C. Bastian and Eduardo Calonje vi Contents 26 Melanoma 1221 30 Cutaneous metastases and Paget's disease Boris C. Bastian and Alexander Lazar of the skin 1421 Doina Ivan, Alexander Lazar and Eduardo Calonje 27 Tumors of the conjunctiva 1268 Jacob Péer and Shahar Frenkel 31 Tumors of the hair follicle 1445 32 Tumors and related lesions of the sebaceous 28 Sentinel lymph node biopsies 1296 glands 1488 Alistair J. Cochran 33 Tumors of the sweat glands 1508 29 Cutaneous lymphoproliferative 34 Cutaneous cysts 1571 diseases and related disorders 1311 35 Connective tissue tumors 1588 John Goodlad and Eduardo Calonje Index I1 Chapter List of Contributors Josette André, MD Alistair J. Cochran, MD Head of the Dermatology and Dermatopathology Department. Distinguished Professor of Pathology and Laboratory CHU Saint-Pierre - CHU Brugmann Medicine and Surgery Hôpital Universitaire des Enfants Reine Fabiola Department of Pathology and Laboratory Medicine Université Libre de Bruxelles David Geffen School of Medicine at UCLA Brussels, Belgium Los Angeles, CA, USA Ch 23: Diseases of the nails with Ursula Sass and Anne Ch 28: Sentinel node biopsies Theunis Antonio C. Cubilla, MD Boris C. Bastian, MD Instituto de Patología e Investigación Chairman, Department of Pathology Asuncion, Paraguay The James Ewing Alumni Chair Ch 12: Diseases of the anogenital skin with Eduardo Member, Human Oncology and Pathogenesis Program Calonje, Sallie Neill, Chris Bunker, Nick Francis and Alcides Memorial Sloan-Kettering Cancer Center Chaux Professor of Pathology Weill Cornell Medical College New York, NY, USA Nick Francis, FRCPath Ch 2: Specialized techniques in dermatopathology with Consultant Histopathologist Pratistadevi K Ramdial, John Goodlad, John A. McGrath and Imperial College Healthcare NHS trust Alexander Lazar Honorary Senior Lecturer Ch 25: Melanocytic nevi with Eduardo Calonje Imperial College Faculty of Medicine Ch 26: Melanoma with Alexander Lazar London, UK Ch 12: Diseases of the anogenital skin with Eduardo Nooshin K. Brinster, MD Calonje, Sallie Neill, Chris Bunker, Alcides Chaux, Antonio C Assistant Professor Cubilla Department of Pathology and Dermatology Director of Dermatopathology Shahar Frenkel, MD, PhD VCU Medical Center Richmond, VA, USA Ocular Oncologist and Ophthalmic Pathologist Ch 13: Degenerative and metabolic diseases Specialized Ocular Oncology Service Ch 14: Cutaneous adverse reactions to drugs Ophthalmic Pathology Laboratory Jerusalem, Israel Chris Bunker, MA, MD, FRCP Lecturer in Ophthalmology Department of Ophthalmology Consultant Dermatologist Hadassah – Hebrew University Medical Center University College and Chelsea and Westminster Hospitals Jerusalem, Israel London; Ch 27: Tumors of the conjunctiva with Jacob Pe'er Professor of Dermatology University College London London, UK John Goodlad, MD, FRCPath Ch 12: Diseases of the anogenital skin with Eduardo Calonje, Consultant Haematopathologist and Honorary Sallie Neill, Nick Francis, Alcides Chaux, Antonio C Cubilla Senior Lecturer Department of Pathology Alcides Chaux, MD Western General Hospital and University of Edinburgh GU Research Fellow, Edinburgh, UK Department of Pathology Ch 2: Specialized techniques in dermatopathology with Johns Hopkins University School of Medicine Pratistadevi K Ramdial, Boris C. Bastian, John A. McGrath and Baltimore, MD, USA Alexander Lazar Ch 12: Diseases of the anogenital skin with Eduardo Calonje, Ch 29 Cutaneous lymphoproliferative diseases and related Sallie Neill, Chris Bunker, Nick Francis, and Antonio C Cubilla disorders with Eduardo Calonje viii List of Contributors Wayne Grayson, MBChB, PhD, FCPath(SA) Sallie Neill, MB ChB, FRCP Consultant Anatomical Pathologist and Dermatopathologist Consultant Dermatologist AMPATH National Laboratories; Guys and St Thomas' NHS Trust Honorary Associate Professor London, UK School of Pathology Ch 12: Diseases of the anogenital skin with Eduardo Calonje, University of the Witwatersrand, Johannesburg Chris Bunker, Nick Francis, Alcides Chaux, Antonio C Cubilla Johannesburg, South Africa Ch 18: Infectious diseases of the skin Jacob Pe'er, MD Ch 19: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome Professor and Chairman (AIDS)-associated cutaneous diseases with Department of Ophthalmology Pratistadevi K Ramdial Jonas Friedenwald Professor of Ophthalmic Research Hadassah – Hebrew University Medical Center Jerusalem, Israel Doina Ivan, MD Ch 27: Tumors of the conjunctiva with Shahar Frenkel Assistant Professor Departments of Pathology and Dermatology Pratistadevi K. Ramdial, MBChB, FCPath(SA) Section of Dermatopathology The University of Texas M.D. Anderson Cancer Center Professor and Head Houston, TX, USA Department of Anatomical Pathology Ch 30: Cutaneous metastases and Paget's disease Nelson R. Mandela School of Medicine of the skin with Alexander Lazar and Eduardo Calonje University of Kwazulu-Natal and the National Health Laboratory Service Durban, South Africa Boštjan Luzar, MD, PhD Ch 2: Specialized techniques in dermatopathology with Professor of Pathology Boris C. Bastian, John Goodlad, John A. McGrath and Consultant Pathologist Alexander Lazar Institute of Pathology Ch 19: Human immunodeficiency virus (HIV) and acquired Medical Faculty University of Ljubljana immunodeficiency syndrome (AIDS)-associated cutaneous Ljubljana, Slovenia diseases with Wayne Grayson Ch 10: Inflammatory diseases of the subcutaneous fat with Eduardo Calonje Rodrigo Restrepo, MD Ch 17: Idiopathic connective tissue disorders with Eduardo Calonje Director, Dermatopathology Fellowship Program Universidad CES; Professor of Dermatopathology John A. McGrath, MD, FRCP Universidad Pontificia Bolivariana; Professor of Molecular Pathology Director, Laboratory of Pathology St John's Institute of Dermatology Clinica Medellin King's College London Medellin, Colombia Guy's Hospital Ch 22: Diseases of the hair with Eduardo Calonje London, UK Ch 1: The structure and function of skin Ursula Sass, MD Ch 2: Specialized techniques in dermatopathology with Pratistadevi K Ramdial, Boris C. Bastian, John Goodlad and Assistant Professor Alexander Lazar Dermatology and Dermatopathology Department CHU Saint-Pierre Université Libre de Bruxelles Dieter Metze, MD Brussels, Belgium Professor of Dermatology Ch 23: Diseases of the nails with Josette André and Anne Director, Dermatopathology Unit Theunis Department of Dermatology University Hospital Münster Münster, Germany Ch 3: Disorders of keratinization List of Contributors ix Anne Theunis, MD Sook-Bin Woo, DMD, MMSc Assistant Professor Associate Professor Dermatopathology and Pathology Department Department of Oral Medicine, Infection and Immunity CHU Saint-Pierre and Institut Bordet Harvard School of Dental Medicine, Boston, MA, USA; Université Libre de Bruxelles Attending Dentist and Consultant Pathologist Brussels, Belgium Brigham and Women's Hospital Ch 23: Diseases of the nails with Josette André and Ursula Boston, MA, USA Sass Co-Director Center for Oral Pathology Strata Pathology Services Inc. Wei-Lien Wang, MD Lexington, MA, USA Ch 11: Diseases of the oral mucosa Assistant Professor Department of Pathology Sections of Dermatopathology and Sarcoma Pathology The University of Texas M.D. Anderson Cancer Center Houston, TX, USA Ch 7: Lichenoid and interface dermatoses with Alexander Lazar Ch 21: Diseases of collagen and elastic tissue with Alexander Lazar