Oral pathology: Clinical pathologic correlations, 5th ed

Abstract

Oral medicine is a discipline where dermatologists are required to have expertise but rarely receive adequate training. A good textbook can go a long way towards alleviating this problem. With a bit of background, dermatologists can relatively easily transfer their observational skills to the oral cavity. I have been a fan of Regezi's Oral Pathology since the first edition appeared in 1989, and am happy to report that the latest edition is even better, with improved pictures and electronic features. Just to clarify the title: in most dental schools, the physicians who diagnose and treat mucosal diseases, as well as interpret oral biopsies, are known as oral pathologists. The orientation of this book is clinical, with just enough histopathology to make everything more understandable. What really sets this textbook apart from all others is that page 1 is found well into the book. The first 75 pages are numbered 0-1 through 0-75 and are devoted to a “Clinical Overview” with a differential diagnostic approach to mucosal, submucosal and jaw lesions. For example, under mucosal disease, the differential diagnosis considerations for vesiculobullous, ulcerative, white, red-blue, pigmented and verrucous lesions are considered. The submucosal lesions also include disorders of dermatologic interest, but only Langerhans cell disease is likely to sound familiar among the bony lesions. All of the diseases mentioned here are discussed in far greater detail in the balance of the text which is structured in almost the same fashion, making it easy to jump from one part to the other. In the body of the text, the presentation is fairly traditional, including sections on etiology and pathogenesis, clinical appearance, histopathology, differential diagnosis, and treatment. In addition, there is a CD with 30 nice case studies with clinical pictures and photomicrographs illustrating a variety of disorders, many of which will be familiar to dermatologists, such as aphthae, lupus erythematosus, lichen planus, pemphigus vulgaris, mucous membrane pemphigoid, and Langerhans cell disease. There is also a student Web site, but there was no way for a physician no longer in training to honestly log in. My acid test of all oral pathology books is leukoplakia—what could be more confusing than a common disease where the stakes including overlooking a squamous cell carcinoma or overdiagnosing an area of frictional hyperkeratosis? These authors define leukoplakia as a white mucosal patch or plaque that cannot be rubbed off and has no other explainable cause. After separating out verrucous hyperplasia and verrucous carcinoma, they are left with a group of flat lesions primarily caused by tobacco which are then diagnosed microscopically as hyperkeratosis, dysplasia or squamous cell carcinoma. This is as workable as anything else, but not truly satisfying. Another problem area is distinguishing between erosive lupus erythematosus and lichen planus in the mouth; while both diseases are well-illustrated and carefully discussed, I did not find any pearls to convince me oral pathologists have any easier a time than we do. There are occasional sentences which seem dermatologically awkward, but I am sure the authors experience many more such moments when reading the oral disease sections in dermatology books. One of contributors is Ginat Mirowski, an oral pathologist and dermatologist known to the readers of this journal; perhaps her presence helps explain the relative dermatologic sophistication. While this is not an officially an atlas, it is abundantly illustrated with high quality clinical pictures, photomicrographs, and imaging studies. Most pictures are 3 in × 2 in, more than adequate for appreciating detail. I recommend Oral Pathology instead of a lavish atlas because it is specifically designed to teach, easy to navigate through, and also a bargain at $110.00.