Journal Review:

Dermatopathology: Practical & Conceptual

Ed Uthman, MD

Diplomate, American Board of Pathology

6 Sep 1996

I don't remember subscribing to this journal, but it appeared in my mailbox anyway:

Dermatopathology (subtitled) Practical and Conceptual, volume 2, number 2, April/June, 1996, Hanley & Belfus, Philadelphia, PA, USA (215) 546-7293, $92/4 issues (US domestic rate for individuals).

I have come to two main conclusions after reviewing this journal:

1) If I owned a vanity publishing house, I would probably publish a journal like this one.

2) This journal is a good reason why dilettantes such as I should not be allowed to own vanity publishing houses.

The first puzzler about this journal is that it is sub-sub-titled "Journal of the Latin American Society of Dermatopathology," despite the facts that its editor-in-chief (A. Bernard Ackerman) is not in or from Latin America; it is not published in Latin America; none of the individuals listed among the senior editorial staff have Spanish or Portuguese surnames; none of the authors of the articles are affiliated with institutions in Latin America; and of the 45 individuals listed as contributing editors, only four are from Latin America (cf., eight from Germany).

But the mysteries behind this quirky journal are only beginning. Of the 15 articles in the issue, five are authored or co-authored by the editor-in-chief. I wonder if he had any trouble getting those manuscripts past the editorial board. Six of the articles were written by authors affiliated with what is continually referred to throughout the issue as "the Institute," as if there were no other. From what I can tell, this must refer to the Institute for Dermatopathology, Jefferson Medical College, Philadelphia, of which the journal's editor-in-chief just happens to be the director.

But nepotism aside, there is quality between these covers. The lead editorial, titled (ungrammatically, BTW) "Caveat Doctore!" features Bernard Ackerman's peerless verbal economy and ability to always choose just the right word (in English anyway). This is a short piece on the behavior of physicians in malpractice suits which covers a lot of ground with few words. At the end I want to stand up and cheer.

Enthusiastically turning the page, I immediately bog down in what initally appears to be a clever practical joke, "Haarscheibe (Hair Disk): Marvel or Myth?" This twelve-page, profusely illustrated article, which (like Patrick Buchanan's 1992 Republican National Convention speech) probably sounded better in the original German, starts off with the exciting lead in, "the concept of the Haarscheibe (hair disk) still remains recondite to dermatologists, dermatopathologists, and physiologists." My eyes glaze over. Next article.

Sandwiched between the Haarscheibe piece and the most bizarre article I have ever seen in a medical journal (see below) is a very useful clinicopathological quiz case by Reimann-Weber et al from Graz, Austria. High quality clinical and histologic photographs accompany the clinical history on one page. Turn the page, and there's the answer and a nice discussion. Das ist ausgezeichnet, Herr Professor Doktor Reimann-Weber.

"And now," to quote Monty Python, "for something completely different." The next article is by Michael Franzblau and is called "Nazi Medical Crimes Unpunished 50 Years Later." This is an unprecedented attempt to prosecute an alleged Nazi war criminal in, of all places, the pages of a derm path journal. Now, the crimes of the Nazis are as serious as they come, but for someone to try to pull off this quixotic attempt at justice in such a venue conjures images not of the Nuremberg trials, but of Q's kangaroo court in Star Trek's "Encounter at Farpoint" episode. The only connection between this article and dermatopathology is that the author is a dermatologist. Sure, let's round up every last Nazi, but please, Dr. Ackerman, leave it to the experts. After all, I don't imagine any of the folks from the Simon Wiesenthal Center are looking over your shoulder at sign-out and kibbitzing your calls.

The next article, by Robert Frazier at al, is kind of interesting. It simply lists all the synonyms for "dysplastic nevus" in chronological order from 1976 to 1995, accompanied by original citations. Believe it or not, amateur nosologists, there are 21 synonyms for this lesion! If this article won't turn you into a noso-nihilist, nothing will.

Next, we have an article by Frank Hancock on a study by which telepathology is used to make really tough diagnoses, i.e., on 26 atypical pigmented lesions. Interestingly, the telepathologist got almost all of them "right." This tends to unsuspend my sense of disbelief though, since it seems to me that in this area of pathology such interobserver reproducibility is virtually unattainable. Maybe we should look at all of our pigmented lesions on a video monitor rather than directly on the microscope. Our precision would be better.

The best article in the issue is not written by either a doctor or a Nazi hunter. It is by a lawyer. "Principles of Behavior of Physicians in Matters Medical-Legal" is by Peter C. Kopff, Esq (although the style of the title is suspiciously Ackermanesque), a malpractice defense attorney. Is is extremely well-written, and I consider it a must-read for anyone looking to be involved in medical litigation.

Other short pieces in the journal are teaching pieces which would be very useful to general pathologists, who, like myself, are stuck with a lot of skin. Mario DiLeonardo's "Diagnosis by Silhouette" piece is particularly useful.

My suggestion to the publisher of Dermatology is to get a no-nonsense, tough-as-nails, cigar-chomping, Perry White-style editor who can maintain some discipline in this idyllic playpen of Wunderkinder. There is some fine talent here, but it needs direction and guidance before it can produce a useful publication worth its rather hefty subscription price.