European Journal of Cardiovascular Medicine

Skin diseases constitute a significant proportion of outpatient and inpatient visits in tertiary care hospitals and represent a wide spectrum of pathological entities ranging from inflammatory and infectious conditions to benign and malignant neoplasms.¹ The skin, being the largest and most visible organ of the body, often reflects both localized pathology and systemic disease processes². Many dermatological conditions present with overlapping clinical features, making precise diagnosis based solely on clinical examination challenging. In such situations, histopathological examination of skin biopsies plays a pivotal role in establishing a definitive diagnosis, understanding disease patterns, and guiding appropriate management and clinical intervention³.Despite advances in diagnostic modalities such as immunohistochemistry, immunofluorescence, and molecular techniques, routine histopathology remains the cornerstone in the evaluation of skin lesions, particularly in resource-limited settings.⁴ A skin biopsy is a simple, safe, and cost-effective procedure that provides valuable information regarding the nature, pattern, and extent of the disease.⁵ Histopathological analysis allows classification of lesions into various reaction patterns such as inflammatory, infectious, granulomatous, vesiculobullous, and neoplastic, thereby narrowing the differential diagnosis and improving diagnostic accuracy. Correlation of histopathological findings with clinical features is essential for optimal patient care, as it helps clinicians decide the appropriate treatment strategy and predict prognosis⁶.The spectrum of skin lesions varies widely depending on geographical location, climate, socioeconomic status, occupational exposure,⁷ hygiene, nutritional status, and genetic factors. Developing countries often report a higher prevalence of infectious and inflammatory dermatoses, while neoplastic lesions are increasingly being recognized due to improved diagnostic facilities and awareness. Tertiary care centers, which cater to a large and diverse population, provide an ideal setting to study the histopathological profile of skin lesions and identify prevailing disease patterns in a given region.⁸ Such data are valuable not only for clinicians and pathologists but also for public health planning and resource allocation.Understanding the histopathological spectrum of skin lesions also aids in identifying uncommon and rare conditions that may otherwise be misdiagnosed or overlooked clinically.⁹ Early and accurate diagnosis is particularly important in conditions with significant morbidity, chronicity, or potential for malignant transformation. Furthermore, histopathological studies contribute to medical education and research by enhancing knowledge of disease morphology and clinicopathological correlation.The objective of the present study was to evaluate the histopathological spectrum of skin lesions encountered at a tertiary care center.^10,11 By analyzing skin biopsy specimens received over the study period, the study aimed to assess the frequency and distribution of various non-neoplastic and neoplastic skin lesions. Such an evaluation helps in understanding regional disease prevalence, identifying common diagnostic patterns, and emphasizing the indispensable role of histopathology in the effective diagnosis and management of dermatological conditions¹².

AIM

To evaluate the incidence, histopathological spectrum, and age- and sex-wise distribution of neoplastic skin lesions in patients.

The study was conducted in the Department of Pathology, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, as a hospital-based prospective study. It included cases of benign neoplastic skin lesions received for histopathological examination during the study period. All indoor and outdoor patients clinically suspected to have malignant skin tumors and who underwent punch, incisional, or excisional skin biopsies were included. These lesions comprised  epidermal or keratinocytic tumors, adnexal (appendageal) tumors, and  melanocytic tumors, where histopathology was essential for definitive diagnosis and classification. Cases of neoplastic skin lesions, malignant skin tumors, mesenchymal tumors, hematological malignancies, metastatic skin deposits, and biopsies that were inadequate for proper histopathological evaluation were excluded from the study to ensure accurate assessment of benign neoplastic skin pathology.

Table 1:Age and Sex Distribution of the Study Population

The study population showed a fairly even age–sex distribution, with the highest proportion of both females (25.22%) and males (24.00%) in the 26–35-year age group, followed by the 15–25-year group. Extremes of age (<15 years and >65 years) constituted the smallest proportion in both sexes, indicating that the majority of cases occurred in the young and middle-aged adult population.

Table 2:Lesion-wise Age Distribution (Total = 230)

The distribution of lesions across age groups shows that epidermal cysts were the most common lesion in all age groups, particularly in the 26–35 and 36–45 years categories. Benign lesions predominated overall, while malignant lesions such as BCC, SCC, malignant melanoma, and sebaceous carcinoma were mainly observed in older age groups, especially after 45 years.

Table 3:Distribution of Malignant Cutaneous Tumors According to Major Histopathological Categories

Among malignant cutaneous tumors, epidermal/keratinocytic tumors were the most common, with squamous cell carcinoma accounting for 55% and basal cell carcinoma for 30% of cases. Adnexal, appendageal, and melanocytic malignancies were relatively less frequent, with malignant melanoma comprising 7.5%, sebaceous carcinoma 5%, and malignant eccrine spiradenoma 2.5% of the total cases.

The age and sex distribution of the study population demonstrates a predominance of young and middle-aged adults.Among females, the maximum number of cases was observed in the 26–35-year age group (25.22%), followed by the 15–25-year group (22.61%).A similar trend was noted among males, with the highest proportion in the26–35-year age group (24.00%) and the 15–25-year group (23.33%).The 36–45-year age group constituted a moderate proportion in both females (18.26%) and males (18.67%).Cases in the 46–55-year age group showed a gradual decline in both sexes.The proportion further decreased in the 56–65-year age group among females and males.The extremes of age, namely below 15 years and above 65 years, accounted for the least number of cases.Overall, females (n=115) and males (n=150) exhibited a comparable age distribution pattern.This indicates that the condition predominantly affects individuals in the economically productive age group.

The age-wise distribution of lesions demonstrates a clear predominance of benign conditions across all age groups.Epidermal cyst was the most frequently encountered lesion, with peak occurrence in the 26–35 and 36–45 year age groups.Pilar cysts and dermoid cysts were also commonly seen, especially in younger and middle-aged individuals.Warts and squamous papillomas showed a higher frequency in the younger age groups, particularly below 35 years.Appendageal tumors such as eccrine tumors, cylindroma, pilomatricoma, and syringocystadenoma papilliferum were infrequent and scattered across different ages.Malignant lesions including basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and sebaceous carcinoma were predominantly observed in older age groups.Basal cell carcinoma and squamous cell carcinoma showed a rising trend after 45 years of age.Rare entities such as malignant transformation of eccrine spiradenoma and proliferating trichilemmal tumor were seen sporadically.Overall, the findings indicate an increase in malignant lesions with advancing age, while benign lesions predominate in younger populations.The maximum number of tumours was found in 5th to 7th decade which was similar to study by Bari V et al¹³. Two cases of malignant melanoma were found in present study one was 11year old and other was 45 year old. In the study by Sonam S¹⁴ age range of malignant melanoma was 28-70years.

The spectrum of malignant cutaneous tumors in the present study shows a clear predominance of epidermal and keratinocytic tumors.Squamous cell carcinoma was the most common malignancy, accounting for 22 cases (55%).Basal cell carcinoma was the second most frequent tumor, contributing 12 cases (30%).Together, these two epidermal tumors constituted the majority of malignant skin lesions.Adnexal and appendageal malignancies were relatively uncommon in comparison.Sebaceous carcinoma was identified in 2 cases, representing 5% of the total.Malignant eccrine spiradenoma was a rare finding, seen in only 1 case (2.5%).Melanocytic tumors formed a small but significant proportion of malignant lesions.Malignant melanoma was observed in 3 cases, accounting for 7.5% of the total.Overall, the findings highlight the predominance of keratinocytic malignancies over adnexal and melanocytic tumors.In the present study SCC accounted for maximum number of cases (55.55%) which is similar to the observations made by Chakravorthy RC et al¹⁵, Deo SV et al¹⁶, Budharaja SNet al¹⁷ and Bari V et al¹³.

The present study highlights that cutaneous tumors predominantly affect young and middle-aged individuals, with a comparable age distribution between males and females, indicating involvement of the economically productive age group. Benign lesions were far more common than malignant ones across all age groups, with epidermal cysts constituting the most frequent diagnosis, especially in the third and fourth decades of life. Malignant tumors showed a clear predilection for older age groups, particularly after the fifth decade, with an increasing trend in squamous cell carcinoma and basal cell carcinoma. Among malignant cutaneous tumors, epidermal and keratinocytic malignancies predominated, with squamous cell carcinoma being the most common, followed by basal cell carcinoma, findings consistent with several previous studies. Adnexal and melanocytic malignancies were relatively rare. Overall, the study emphasizes the age-related variation in the spectrum of cutaneous tumors and reinforces the importance of early diagnosis and histopathological evaluation for appropriate management and prognosis.

1. Sternberg Douglas C. Parker DC; Morris RJ;  Solomon AR. Nonneoplastic Diseases of the Skin. Mills, Stacey E. In: Sternberg's Diagnostic Surgical Pathology, 5th Edition. 2010 Lippincott Williams & Wilkins. P. 2-38
2. Pruden SJ; Crone KG; Lind AC. Skin: Nonneoplastic Dermatopathology. Humphrey PA; Dehner L P; Pfeifer JD. In: Washington Manual of Surgical Pathology, 2nd Edition, 2012 Lippincott Williams & Wilkins p. 579-594
3. Santa Cruz DJ; Walsh SN. Tumors of the Skin. Christopher D.M. Fletcher.—4th ed. Diagnostic histopathology of tumors Volume 1 PN 9996090442:2013 by Saunders, Elsevier Inc. p. 1680-1795.
4. Scrivener Y, Grosshans and Cribier B. Variations of BCC according to gender,age, location and histological type. British journal of Dermatology 2002: 147:41-47.
5. Kirkham N. Tumours and cysts of the epidermis. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P- 805-866.
6. Caplan RM: The natural course of urticaria pigmentosa. Analysis and follow-up of 112 cases. Arch Dermatol  1963; 87:144-157
7. Xu X; Erickson LA; Elder DE. Diseases Caused by Viruses. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-651-679.
8. Sellheyer K; Haneke E. Protozoan Diseases and Parasitic Infestations. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-635-650.
9. Lucas S. Bacterial Diseases. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-551-590.
10. . Hinshaw M.Longley JB. Fungal Diseases. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-603-634.
11. Maize J; Jr Maize J; Metcalf J. Metabolic Diseases of the Skin. Elder David E.; Elenitsas Rosalie; Johnson Bernett L; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-435-467.
12. Mcnutt SN; Moreno A; Contreras FA lix. Inflammatory Diseases of the Subcutaneous Fat. Elder David E.; Elenitsas Rosalie; Johnson Bernett L.; Murphy George F. In: Lever's Histopathology of the Skin, 9th Edition, 2005 Lippincott Williams & Wilkins P-519-549.
13. Vaibhav Bari, Prashant Murarkar, Alka Gosavi, Kalpana Sulhyan, Skin Tumours – Histopathological Review of 125 Cases.Page 417-428.
14. Dr. SONAM S. SHAIKH. HISTOPATHOLOGICAL STUDY OF SKIN TUMOURS, 2011.p. 64-114
15. Charkravorthy RC and Choudhuri DR. Malignant neoplasms of the skin in Eastern India. The Indian Journal of Cancer, vol 5,1968:133-144.
16. Deo SV. Surgical management of skin cancers: Experience from a regional cancer centre in North India. Indian Journal of Cancer 2005; 42:145-50.
17. Budharaja SN, Pillai VCV, Periyanagam WJ, Kaushik SP and Bedi BMS. Malignant neoplasms of skin in Pondicherry- a study of 102 cases. The Indian
18. Journal of Cancer,1972: 284-295.