Spectrum of neoplastic and non neoplastic skin lesions: A histopathological institutional study

Introduction: Skin lesions are complex due to wide range of neoplastic and non-neoplastic lesions. Several studies showed high prevalence of skin disorders in developing countries. Clinical presentation is restricted to hyperpigmentation, hypopigmentation, macules, papules and nodules but histopathology is highly variable. Accurate diagnosis is needed due to disease specific treatment and prognosis. Aim of the study is to evaluate different histopathological patterns of skin lesions for accurate diagnosis and to analyze age and sex distribution of skin lesions. Materials and Methods: The study included a total number of 125 skin biopsies from July 2018 to June 2019 sent for histopathological examination to pathology department, SVS Medical College, Mahabubnagar, Telangana, India. Results: In our study total 125 cases were analyzed. Out of which majority of the lesions (38.97 %) were in the age group of 21-40 years. Present study showed cutaneous cysts being the most common non-neoplastic lesion. In malignant tumors, out of 20 cases, 50% cases were Squamous cell carcinoma followed by basal cell carcinoma (30%). Conclusion: Even though clinical features are few biopsy shows varied pathology and it is crucial for accurate diagnosis and differential diagnosis of skin lesions. Skin biopsy is a simple, inexpensive and gold standard method for definitive diagnosis and treatment of skin lesions. In the present study, n on neoplastic lesions are more common than neoplastic skin lesions. Non neoplastic lesions more common in younger males of 21-40 yrs and neoplastic lesions in older age group. Epidermal cyst is most common non neoplastic lesion followed by trichilemmal cyst. Squamous papilloma is the most common benign neoplasm & Squamous cell carcinoma is the most common malignant neoplasm. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/)


Introduction
The skin is a complex organ with many functions and three anatomic components: epidermis with skin adnexa, melanocytic system, and dermis and subcutis. 1 Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum. 2 It varies from country to country and various regions within a country. This variation is also influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. 3 Majority of skin lesions are diagnosed on the basis of clinical presentation and history. The histological diagnosis in turn is used by clinicians to aid in the management of patients and most appropriate clinical interventions. 4 Clinical diagnosis of different entities is often difficult, as most of the appendageal tumors present as asymptomatic papules or nodules. Anatomical location, number and distribution of lesions provide important clue but histopathology is invaluable in confirmation of the diagnosis. 5 The present study was carried out with an aim of describing the spectrum of various dermatological lesions in different ages groups and sexes during a period of one year.

Material and Methods
In the present study, prospective study was done in Department of Pathology, SVS Medical College, Mahabubnagar, from July 2018 to June 2019. All skin biopsies received were diagnosed based on routine histological examination on haematoxylin and eosin stained tissue sections. Clinical history and relevant data were recorded. Relative frequency of different lesions, age and sex distribution were analysed.

Inclusion criteria
All skin biopsies that showed specific pathology were included.

Exclusion criteria
Oral mucosal biopsies, inadequate and inconclusive biopsies were excluded.

Results
The present study was a prospective study of skin lesions from July 2018 to June 2019. A total of 125 cases were included in the study, out of which 77(61.60%) were non-neoplastic and 48(38.40%) were neoplastic. There were 73(58.40%) males and 42(41.60%) female with male: female ratio of 1.7:1 Among both males and females, the most common lesion was epidermal inclusion cyst (n=19, 15.2 % & n=13, 10.4 % respectively). The second most common lesion in both males and females was Squamous cell carcinoma (n=6, 4.8 % & n=4, 3.2 % respectively). Age and sex wise distribution of skin lesions is tabulated in Table 1.
Maximum number of cases belong to 21 -30 years age group with males predominating the group (n=10). Maximum number of cases in the present study were cutaneous cysts (41.6 %) followed by benign skin tumors (22.4 %) and malignant skin tumors (16.0 %) ( Table 3).
Among the non-neoplastic lesions of skin, one case of Darries disease ( Figure 1) (1.30%) and Discoid lupus eythematos us (1.30%) were reported and both were females. One case of Bullous pemphigoid was reported in a male patient. $ cases of Hansen's, 3 cases of Lichen planus (3.90%) and 2 cases of Psoriasis (2.60%) were reported, all showed male preponderance. 3 cases of calcinosis cutis (3.90%) and implantation dermoid (3.90%) were diagnosed, both showed male preponderance. 2 cases of hypertrophic scar (2.60 %) and pyogenic granuloma (2.60%) were reported and showed equal sex distribution. One case of corn(1.30%) was reported in female patient (Table 4).
2 cases of seborrheic keratosis, verruca vulgaris, proliferatiing trichilemmal cyst, blue nevus and dermatofibroma were reported which showed equal sex distribution. 2 cases on intradermal nevus were reported and both were females. One case of Bowen's disease and Nevus sebaceous of Jadossahn each was reported and all were males. One case of Trichoepithelioma (Figure 1), Trichilemmoma and Spitz nevus were reported and all were females.
In the present study, maximum number of benign skin tumors (42.86%) were seen between 31 -50 years and female predominance with male to female ratio of 0.7:1. Among 28 benign tumors, squamous papilloma (28.59 %) was the most common lesion followed by pilomatrixoma (10.72 %) and both showed male predominance (Tables 4  and 5).  In the present study, maximum number of malignant tumors were seen between 41 -80 years and showed female preponderance with male to female ratio of 1.25:1. Among 20 cases of malignant tumors, squamous cell carcinoma was most common (50 %) followed by basal cell carcinoma (Figure 1).

Discussion
In the present study, a total number of 125 cases were included, out of which 77 cases were non-neoplastic and 48 cases were neoplastic. There was male preponderance in our study when compared to females similar to the study done by Grover et al (2008) 6  In the present study, most common malignant tumor reported was squamous cell carcinoma followed by basal cell carcinoma. Similar findings were noted with the studies done by Dr. Sheela L Gaikwad et al (2016) and Abubakar et al (2016) 15 . The prevalence of various skin diseases varies according to geographical area and is related   to racial, environmental and socioeconomic factors of the population. 16

Conclusion
In our study, wide spectrum of skin lesions were diagnosed, though less in number but were noticeable. Non-neoplastic lesions were the major entity with epidermal cyst being the predominant one. Squamous cell carcinoma was the major malignant lesion. Histopathological examination combined with clinical findings help in proper diagnosis, predicting the treatment and prognosis. As the skin biopsy is fast, simple and done at little inconvenience to the patient, the entire spectrum of disease process can be correlated clinically and pathologically. Thus, timely reporting of skin diseases is of great importance for reducing disease burden and improving quality of life.

Source of funding
None.

Conflict of interest
None.