A Histomorphological Study of Malignant Skin Tumors

Background: Malignant skin tumors are an important public health problem. Exposure to UV radiation is a significant risk factor in the development of these tumors. The most common skin malignancies are basal cell and squamous cell carcinomas, which have an excellent prognosis and a relatively low mortality rate. Methods: A retrospective study was done on 46 cases with histopathological diagnoses of malignant skin tumors, over a period of two years, in a tertiary care centre in Bagalkot, with the primary objective to demonstrate the distribution of cases according to age, sex and site of these tumors. Results: Malignant skin tumors were most commonly seen in the age group of 51 to 60 years (30.5%). Male to female ratio was 2.2:1. Squamous cell carcinoma (56.5%) was the most common tumor followed by basal cell carcinoma (21.7%), verrucous carcinoma (10.9%) and malignant melanoma (4.3%). Rare tumors such as sebaceous carcinoma and trichilemmal tumor were also noted in this study. Conclusion: Histopathology remains the gold standard for the diagnosis, management and follow-up of patients with malignant skin tumors. Key-wordsMalignant tumors, Skin tumors, Carcinomas, Histomorphology INTRODUCTION The skin is the largest organ of the body. More than hundred different types of tumors are known to be clinically apparent on the skin due to the complexity of its structure with multiple cell types. These cell types may undergo malignant transformation at various stages of their differentiation, leading to tumors with distinct histology and varied clinical behaviour. the incidence of skin tumors has increased dramatically over the last few decades, at least in part, as a result of increasing sun exposure, necessitating vigorous surveillance [2] though, genetic and environmental factors may play a role. Skin tumors are so ubiquitous that they can affect people of all ages, however, the frequency of skin cancer increases with age. [4] Access this article online Quick Response Code Website: www.ijlssr. com DOI: 10.21276/ijlssr.2017. 3.4. 11 Although the non-melanoma and melanoma skin cancers encompass the vast majority of skin cancers, there are a large number of other malignancies of the skin that are less commonly confronted by the clinicians. Neoplasms of the skin classically have been divided into those that differentiate from the epidermis, dermis, adnexal structures of the skin, and those derived systemically. Difficulties arise because of the variety and complexity of histologic, ultra-structural and histochemical study, complex nomenclature, multiple classifications and conflict in opinion regarding histogenesis of some of the entities and relative rarity of these tumors. Skin tumors, at times pose a great challenge to surgeons as some of benign tumors can be confused with malignant tumors. Hence, it is vitally important to intervene, as some can become metastatic resulting in morbidity and mortality. Most of the time clinical diagnosis may not be accurate because of similarity in gross appearance. Even sophisticated investigations such as computerized tomography and tumor markers may not be useful in skin tumors. In such cases, histopathology alone remains a diagnostic tool, and so the histopathological investigation of excised skin lesions yields a high percentage of pre-malignancies and malignancies. This indicates that all excised skin lesions must ARTICLE RESEARCH Int. J. Life Sci. Scienti. Res., 3(4) JULY 2017 Copyright © 2015-2017| IJLSSR by Society for Scientific Research is under a CC BY-NC 4.0 International License Page 1163 undergo a histopathological investigation to ensure that malignancies are not missed. Thus, early recognition, diagnosis and treatment offer the best chance for cure. The knowledge of histopathological patterns can help in the prognosis and planning an effective management. This study was conducted to study and characterize the malignant skin tumors based on histopathological features. Comparison of the site distribution and age pattern of different types of skin cancers can be an important source of etiological clues, and thus was included in our study. MATERIALS AND METHODS The present study was a retrospective study of malignant skin tumors was carried out in during the period of two years from January 2014 to December 2016 in the department of pathology in a tertiary care centre, Karnataka, India. This study included tumors of the epidermis along with melanocytic tumors and adnexal tumors of skin without restricting the study to any particular age limit. Mesenchymal tumors of skin, hematological tumors of skin, neural tumors of skin, non-neoplastic lesions of skin and all tumors arising from the mucosal area of muco-cutaneous junction such as glans penis and eyelid margin were excluded. The study was retrospective and was done during the period of January 2014 to December 2016 (2 years). Data for the study was obtained from departmental records, tissue blocks and slides. Clinical details were obtained and maintained according to the proforma. All the biopsies and resected specimens received in the histopathology section were immediately fixed in 10% formalin for 24 hours. Gross features of the specimen were noted. Multiple sections of the specimen were taken. Then they were processed and embedded in paraffin wax. Three-five microns thick sections were prepared and then stained with Haematoxylin & Eosin (H&E) and histopathological analysis was made. Detailed study of the sections was performed under the light microscope and then the final diagnosis was done. RESULTS This study included 46 cases out of which 32 (69.5%) were males and 14 (30.5%) were females with male to female ratio of 2.2:1. The age group varied from 10 years to 90 years and the mean age was 52.41 years. The commonest age group in which malignant skin tumors were noted was in the range of 51 to 60 years (30.5%) (Fig. 1), in which 8 (57.1%) had squamous cell carcinoma (SCC), followed by 5 (35.7%) of basal cell carcinoma (BCC). Fig. 1: Distribution of cases, according to Age (Years) Out of the 46 cases, the most frequently diagnosed malignant skin tumor was SCC with 26 cases (56.5%), followed by 10 cases (21.7%) of BCC (Table 1). Table 1: Distribution of cases, according to histopathological diagnosis Diagnosis Number of Cases (%) Squamous Cell Carcinoma (Fig. 2a, 2b) 26 (56.5) Basal Cell Carcinoma (Fig. 3a, 3b) 10 (21.7) Verrucous Carcinoma 5 (10.9) Sebaceous Carcinoma (Fig. 4a, 4b) 2 (4.3) Malignant Melanoma 2 (4.3) Trichilemmal Carcinoma 1 (2.2)