European Journal of Cardiovascular Medicine

Skin is the largest organ of the body and reflects both local and systemic health, serving as an important site for the development of a wide spectrum of neoplastic conditions¹. Among these, benign skin neoplasms constitute a significant proportion of dermatological and pathological practice. Historically, the skin was viewed largely as a protective covering for internal organs, a concept emphasized by Rudolf Virchow, but advances in dermatopathology have highlighted its complex structure and susceptibility to diverse proliferative lesions². Benign neoplasms of the skin arise from various components including the epidermis, dermis, adnexal structures, melanocytes, vascular tissue, and neural elements.³ Although non-malignant, these lesions often pose diagnostic challenges because of their clinical resemblance to premalignant or malignant conditions and their potential cosmetic and psychological impact on patients.⁴Benign epidermal tumors are among the most commonly encountered lesions and include seborrheic keratosis, epidermal nevus, and pseudoepitheliomatous hyperplasia. These lesions typically present as slow-growing, well-circumscribed growths with characteristic clinical appearances, yet histopathological examination remains essential for confirmation, particularly in atypical cases^5,6. Epithelial cysts, such as epidermoid cysts, trichilemmal cysts, and dermoid cysts, represent another important category of benign neoplasms. These cystic lesions arise from follicular or developmental remnants and are frequently encountered in routine clinical practice.Adnexal tumors form a diverse group of benign neoplasms derived from hair follicles, sebaceous glands, and sweat glands (eccrine and apocrine).⁷ Examples include trichoepithelioma, syringoma, spiradenoma, hidradenoma, and sebaceous adenoma. These tumors often exhibit distinctive histological patterns reflecting their line of differentiation, and accurate diagnosis relies heavily on morphological assessment.⁸ Although benign, some adnexal tumors may be associated with genetic syndromes or may rarely undergo malignant transformation, necessitating careful evaluation.Benign melanocytic neoplasms, commonly referred to as nevi, are extremely prevalent and may be congenital or acquired.^9,10 They include junctional, compound, and intradermal nevi, each defined by the anatomical distribution of nevus cells. While most nevi are innocuous, their clinical significance lies in differentiation from malignant melanoma, underscoring the importance of histopathological examination in lesions showing asymmetry, color variation, or recent change.Vascular tumors such as hemangiomas and lymphangiomas, and neural tumors like neurofibroma and schwannoma, also fall under benign skin neoplasms. These lesions may be present at birth or develop later in life and are often associated with systemic conditions or syndromes.¹¹ Despite advances in immunohistochemistry and molecular diagnostics, routine histopathology remains the cornerstone for diagnosing benign skin neoplasms due to its accessibility, cost-effectiveness, and reliability.In summary, benign neoplasms of the skin encompass a broad and heterogeneous group of lesions arising from different cutaneous components. Accurate diagnosis through careful clinical correlation and histopathological evaluation is essential to distinguish them from malignant counterparts, guide management, and alleviate patient anxiety while preventing unnecessary aggressive treatment.¹²

AIM

To study the histopathological features, incidence, and age- and sex-wise distribution of benign 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 non-neoplastic skin lesions received for histopathological examination during the study period. All indoor and outdoor patients who were clinically suspected to have non-neoplastic skin conditions and who underwent punch, incisional, or excisional skin biopsies were included. These lesions primarily comprised inflammatory, infectious, granulomatous, psoriasiform, and vesiculobullous dermatoses, where histopathology was required for definitive diagnosis or clinicopathological correlation. Cases diagnosed as 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 non-neoplastic skin pathology.

Table 1:Age and Sex Distribution of Patients with Skin Lesions (n = 90)

The majority of patients belonged to the 21–30 year age group, with a clear male predominance across most age categories. Overall, males constituted a higher proportion of cases than females, with peak incidence observed in the young adult and middle-aged groups.

Table 2:Sex-wise Distribution of Non-Neoplastic Skin Lesions in the Study Population (n = 90)

Leprosy was the most common diagnosis in both males and females, followed by psoriasis and lichen planus, with an overall male predominance. Most other non-neoplastic skin lesions showed low individual frequencies and no marked sex predilection.

Table 3: Distribution of Benign Skin Lesions (n = 54)

Epidermal or keratinocytic tumors constituted the majority of benign neoplastic skin lesions, with warts being the most common, followed by squamous papilloma and pseudoepitheliomatous hyperplasia. Adnexal tumors and melanocytic tumors were less frequent, with intradermal nevus representing the only melanocytic lesion observed.

The age and sex distribution of patients showed a clear male predominance, with males accounting for 55 out of 90 cases. The highest incidence of skin lesions was observed in the 21–30 year age group, followed by the 31–40 year and 41–50 year age groups, indicating greater involvement in young and middle-aged adults. Females showed a relatively higher proportion of cases in the 31–40 and 41–50 year age groups. Pediatric cases (<10 years) constituted a small proportion of the study population. The incidence gradually declined after 60 years of age in both sexes. Very few cases were observed in patients above 70 years. Overall, skin lesions were more common in the economically active age groups.The incidence of infectious diseases was highest among non-neoplastic lesions 48 cases, 39.34%. Maximum no. of cases were found in male with male to female ratio of 2.43:1, which was similar to study by Pawale J et al¹³(1.18:1).

The distribution of non-neoplastic skin lesions in the present study showed a clear male predominance, with males constituting 55 out of 90 cases. Leprosy emerged as the most common diagnosis, accounting for 20% of cases, with equal distribution among males and females. Psoriasis was the second most common condition and showed a higher frequency in males compared to females. Lichen planus was another frequently encountered lesion with nearly equal sex distribution. Vesiculobullous disorders such as pemphigus and bullous pemphigoid were seen more commonly in females. Infectious dermatoses including lupus vulgaris, cutaneous leishmaniasis, and mycetoma were predominantly observed in males. Autoimmune conditions like lupus erythematosus showed a female preponderance. Several conditions such as calcinosis cutis, hidradenitis suppurativa, and urticaria pigmentosa were seen exclusively in males. Many lesions, including pityriasis rosea and panniculitis, were infrequent in occurrence. Overall, the spectrum of non-neoplastic skin lesions demonstrated varied sex distribution with certain diseases showing distinct gender predilection.Maximum no.of cases were found of leprosy 24 cases, 50% followed by lupus vulgaris 8 cases 16.67%.  This finding was similar to study by Singh R et al¹⁴(46.15% leprosy and 11.15% lupus vulgaris).

Lepra stain was positive in 11 cases(45.83%), similar to study by  Pawale J et al¹³(56.66%).  Cutaneous leishmaniasis was found in 4.17% cases, which was concordant with study by Amanjit Bal et al¹⁵(1.16%).

Fungal infections including mycetoma and fungal granuloma was found in 20.83%.  The study by N.Asokan et al¹⁶ found fungal infection 18.74%.

Calcinosis cutis(3cases) was found in male in age range of 20-50 years. Study by Singh R et al¹⁴ showed male predominance and maximum cases in 40-60 years of age group.

Three cases of molluscum contagiosum were found in male, which concordant with study by Mehar R er al.¹⁷

The present study showed that epidermal or keratinocytic tumors formed the largest group of benign neoplastic skin lesions, accounting for the majority of cases. Among these, warts were the most common diagnosis, comprising nearly one-third of all benign neoplasms. Squamous papilloma and pseudoepitheliomatous hyperplasia were also frequently encountered epidermal tumors. Seborrheic keratosis and keratoacanthoma were less common but clinically significant lesions. Adnexal or appendageal tumors constituted a smaller proportion of cases and demonstrated considerable histological diversity. These included tumors of hair follicle origin such as proliferating trichilemmal tumor and pilomatricoma, as well as sweat gland tumors like hydrocystoma, cylindroma, syringocystadenoma papilliferum, eccrine adenoma, and eccrine spiradenoma. Trichoepithelioma was an infrequent finding among adnexal tumors. Melanocytic tumors were least common, with intradermal nevus being the only lesion observed in this category. Overall, the study highlights the predominance of epidermal tumors among benign skin neoplasms, emphasizing the importance of histopathological examination for accurate diagnosis and classification.

Study by Reddy BR et al¹⁸showed 40% Erythematous, papulo-squamous lesions with male to female ratio of 3.44:1 and maximum cases in 31-40 year of age group. Psoriasis 42.5%, followed by Lichen planus 30%, Pityriasis rosea 5% and Pityriasis lichenoidis 3.75%. According to Mohd Yunus et al¹⁹, psoriasis is a common  and showed male predominance.

The present study highlights that skin lesions are more common in males and predominantly affect young and middle-aged adults, reflecting greater exposure to environmental, occupational, and infectious factors. Among non-neoplastic lesions, infectious dermatoses formed the largest group, with leprosy emerging as the most common diagnosis, followed by lupus vulgaris, findings that are consistent with several previous Indian studies. Vesiculobullous and autoimmune disorders showed a relative female preponderance, while fungal and parasitic infections were more frequent in males. Benign neoplastic lesions were dominated by epidermal and keratinocytic tumors, particularly warts, with adnexal and melanocytic tumors occurring less frequently. Overall, the study underscores the wide clinicopathological spectrum of skin lesions and emphasizes the pivotal role of histopathological examination in establishing an accurate diagnosis, guiding management, and enabling meaningful comparison with existing literature.

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