898 Book reviews Journal of the

American Academy of Dermatology

The book's major drawback relates to its re- stricted audience. Although chapters are included on shaving preparations and management of male pattern alopecia, it is doubtful whether the major- ity of material would appeal to many male indi- viduals. Also, the material requires some degree of sophistication on the part of the reader.

In summary, practicing dermatologists might well want to recommend Saving Face to their fe- male patients who desire more in-depth education on facial care and maintenance than can be ac- commodated on a limited office visit.

Susan C. Hurt, M.D., Augusta, GA

A B S T R A C T S

Conservative treatment of oesophageal strictures in patients with recessive dystrophic epidermolysis bullosa

Weidauer H, Feurle GE, Bau ldauf G, Anton-Lamprecht I. Laryngol Rhinol Otol (Stuttg) 1985;64:522-6 (German)

Stenosis or complete occlusion of the esophagus is a potentially life-threatening complication of recessive dystrophic epidermolysis bullosa. Consequences are malnutrition, growth retardation, aspira- tion, and cachexia. Total replacement of the esophagus by colon interposition has been recommended in such patients. The authors report on successful conservative management, applying recently developed knowledge concerning the defective eollagenase involved in this disorder and esophageal dilatation. Phenytoin has been shown to reduce the excessive production of collagenase and thereby to diminish blistering of skin and mucous membranes and stricture for- mation of the esophagus. Stepwise dilatation of esophageal strictures instead of bottgienage represents a less traumatic way to restore the esophageal feeding tubes that may be removed later on after suc- cessful dilatation. Esophageal passage has been maintained for up to 4 years, The management of these severe complications of recessive dystrophic epidermotysis bullosa requires interdisciplinary efforts of dermatologists, internists, and otorhinolaryngologists.

Yehudi M. Felman, M.D.

Subungual keratoacanthoma

Brauninger W, Hoede N. Hautarz t 1986;37:270-3 (German)

Subungual keratoacanthoma is very rare, only fourteen cases hav- ing been reported in the literature. In this location it is a painful lesion that fails to regress spontaneously. On x-ray examination de- struction of the underlying bone, caused by pressure, can be seen. Consequently, it is difficult to distinguish clinically between subun- gual keratoacanthoma and other subungual tumors, especially squa- mous cell carcinoma. Biopsy is mandatory to establish the diagnosis correctly before surgical removal. Complete excision, with due con- sideration for underlying bone and joint structures, is the treatment of choice.

Yehudi M, Felman, M.D.

Neuropathological findings in von Reckinghausen disease

Hauw JJ, Duyckaerts C, Henin D, et al. Sem Hop 1985;61:2687-9 (French)

Neurofibromatosis gives rise to a number of lesions of the pe- ripheral and central nervous system, including benign and malignant

tumors, hyperplasias, and dysplaslas. Most lesions of the peripheral nervous system are tumors: neurofibromas, neuromas, and various malignancies. Central nervous system lesions include tumors (optic nerve gliomas, astrocytomas, ependymomas, meningiomas, acoustic neurinomas) and dysembryoplasic lesions (hamartomas, malfor- mations).

Yehudi M. Felman, M.D.

Amelanotie lentigo maligna melanoma

Hofmann H, Linche-Plewig H, Plewig G. Hautarzt 1986;37:281-3 (German)

While amelanotic melanoma is not uncommon, amelanotic len- tigo-maligna melanoma is very rare, only three eases having been reported in the world literature. The authors report a 69-year-old woman with skin type 1 [Editorial note: very light skin] with a fiat, slightly reddish nodule on her left calf of 10 years' duration. (Biopsy examination in 1979 revealed no neoplasia.) Three satellite loci were also present. Biopsy examination showed an amelanotie lentigo ma- ligna melanoma, level llI, tumor thickness, 0.64 ram. Clinically the lesion was suggestive of Bowen's disease; excision of the entire involved area with a 5-cm margin was carried out, followed by a full-thickness skin graft.

Yehudi M. Felman, M.D.

Etretinate and 5-fiuorouracil in intraanal Bowen's disease

Schmidt K-U, Wiskemann A, Mensing H. Hautarzt 1986;37:278-80 (German)

A 38-year-old woman was found in 1978 to have genital Bowen's disease. In 1979 a vulvectomy was performed, followed by a hys- terectomy in 1980. In 1983 she was found to have perianal and intra- anal Bowen's disease, biopsy-confirmed. She was treated by insertion of three 0.1-gm 5-fluorouracil suppositories daily for 31 days. Proc- toscopy 14 days later showed great clinical improvement, but mi- croscopic deposits of tumor on biopsy examination were still present. The 5-FU suppository therapy was resumed for 6 weeks along with oral etretinate, 1 mg/kg. Subsequent proctoscopic biopsy examination failed to reveal any more evidence of tumor.

While local 5-FU has been widely used in the treatment of Bow- en's disease for years, there have been only a few reports in the literature of successful treatment with etretinate. The success of this approach avoided surgical intervention, a rectal amputation, for this patient.

Yehudi M. Felman, M.D.