|Year : 2016 | Volume
| Issue : 3 | Page : 1124-1126
Clinicopathological correlation of skin tumors: A dermatologist's perspective
Namitha Chathra, Ramesh Bhat
Department of Dermatology, Father Muller Medical College and Hospital, Mangalore, Karnataka, India
|Date of Web Publication||4-Jan-2017|
Department of Dermatology, Father Muller Medical College and Hospital, Kankanady, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Tumors of the skin may be encountered by a dermatologist either as presenting complaints or as incidental findings. Certain tumors are easily recognized clinically, while others can only be diagnosed by histopathology.
Aims and Objectives: To analyze the pattern of skin tumors through clinical and histopathological correlation and to assess the role of a dermatologist in the treatment of tumors.
Materials and Methods: A retrospective analysis of histopathologically-diagnosed skin tumors seen in dermatology outpatient department from May 2011 to June 2013.
Results: Forty cases of skin tumors were histopathologically reported during the period under review. Out of this, nine cases were malignant, the nonmelanoma to melanoma ratio being 8:1.
Conclusion: Dermatologists are recommended to monitor closely the changing pigmented or hyperkeratotic lesions and poorly healing ulcers to facilitate early diagnosis and effective management.
Keywords: Excision, histopathology, skin tumors
|How to cite this article:|
Chathra N, Bhat R. Clinicopathological correlation of skin tumors: A dermatologist's perspective. J Can Res Ther 2016;12:1124-6
| > Introduction|| |
The skin is a heterogeneous organ with varied elements having ectodermal and mesodermal origins. Most of these individual elements are capable of producing skin tumors. Based on their primary site of origin, they can be divided into the following:
- Keratinocytic tumors
- Melanocytic tumors
- Appendageal tumors
- Soft tissue tumors.
Therefore, the number of different skin tumors exceeds that of any other organ system.
Benign skin tumors such as syringoma, skin tags are commonly encountered by a dermatologist and are almost considered to be physiological in the elderly.
Although not as frequent, the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is increasing worldwide, Caucasians being the primary victims. However, everyone, regardless of skin color, can fall prey to it. Unfortunately, many patients and even some physicians are under the impression that nonCaucasian people are immune to this disease. That is one reason, people of color are diagnosed with skin cancer at later stages. These delays mean that skin cancers are often advanced and potentially fatal, whereas most skin cancers are curable if caught and treated in a timely manner.
These tumors can show an extraordinary variation in their structure, and it is this variation that causes difficulties in some cases in establishing a definitive pathological diagnosis. The aid of histopathology is crucial in clinching the right diagnosis and in further management.
Traditionally, smaller lesions have been the domain of dermatologists, while the larger and deeper masses were considered a surgeon's forte. Malignant lesions, even when small, have been referred to the surgeon for management. Nevertheless, the role of a dermatologist is rapidly expanding in many disciplines, management of skin tumors being one of them.
| > Materials and Methods|| |
Data of histopathologically-diagnosed skin tumors seen in dermatology outpatient department from May 2011 to June 2013 were collected. Detailed history, type of tumor, diagnostic category, site, size, and any other associated disorders were recorded. Cases were classified based on the tissue of origin and further as benign or malignant. The treatment given was documented. Confidentiality was maintained regarding the identity of the patients. The collected data was analyzed by frequency, percentage, and Chi-square test.
| > Results|| |
We came across a total of forty cases of histopathologically diagnosed skin tumors during our study period. The types of tumors encountered by us are enumerated in [Table 1]. The most common age group affected was between 45 and 55 years. Female patients were more affected than males, male to female ratio being 2:3. A whopping majority (thirty out of forty) of the patients had lesions on the sun-exposed regions, including the face, neck, and the upper extremities. We encountered nine malignant tumors; wherein, nonmelanoma skin cancer outnumbered malignant melanoma in the ratio of 8:1.
|Table 1: Histopathologically diagnosed skin tumors during the last 2 years in the Dermatology Department of a Tertiary Care Centre|
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| > Discussion|| |
Most of the tumors were easily recognizable clinically; hence, in these cases, histopathology was just a tool to confirm the diagnosis. However, a few cases had dubious clinical appearance and required clinicopathological correlation. One such case was that of a 50-year-old man who presented with a solitary verrucous growth measuring 5 cm × 5 cm on his right leg which prompted us to consider SCC, but on histopathological examination, it was revealed to be a giant keratoacanthoma [Figure 1] and [Figure 2]. In total, we came across nine cases of malignant lesions in the last 2 years. Nonmelanoma skin cancers seem to be more common than melanomas. Patients with benign lesions were not amenable for a biopsy; hence, we saw lesser numbers of the same in our study.
|Figure 1: Solitary hyperkeratotic growth seen over the anterior surface of the right leg. A few lichen planus lesions are seen surrounding the growth. Ulcerated area is the site of biopsy|
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|Figure 2: A central, keratin-filled crater with irregular epidermal proliferations extending both upward and downward from the base of the crater (H and E, ×10)|
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Benign lesions such as seborrheic keratoses and syringomas were treated with the help of electrodessication. Slightly larger benign lesions such as neurofibroma, adenoma sebaceum, and trichoepithelioma were treated using carbon dioxide laser [Figure 3]a and [Figure 3]b. Keratoacanthoma, being a precancerous lesion, was treated by excisional biopsy. However, the patient with giant keratoacanthoma was referred to a plastic surgeon for excision followed by skin grafting. Curettage with electrodessication was performed on a BCC lesion arising adjacent to the right inner canthus. On follow-up after 6 months, there was no recurrence of the lesion and extreme satisfaction was expressed by the patient in terms of final cosmetic outcome [Figure 4] and [Figure 5]. The deeper malignancies were referred to the surgeon for a wider excision.
|Figure 3: Adenoma sebaceum: before (a) and after (b) treatment with CO2laser|
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| > Conclusion|| |
The last few decades have seen a worldwide increase in the per-capita increase in the skin cancer burden, but fortunately, India is at the bottom of this list. Nevertheless, it is necessary for the dermatologists to have a profound knowledge on skin tumors as they hold a key role in all phases of care, including prevention, diagnosis, treatment, and follow-up. Detection at a nascent stage can also be aided by the patients and primary care givers by making them aware of signs that are easy to detect early on, such as change in color or size of the lesion. Histopathology is helpful not only just in arriving at a diagnosis but also in formulating the right treatment strategy. Recent studies have emphasized the importance of biopsy for histologic evaluation in the cases showing a persistent cutaneous plaque or nodule without pathognomonic clinical features that permit a definite clinical diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]