HISTOPATHOLOGICAL SPECTRUM OF SKIN LESIONS IN A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY

The skin is the largest organ of the human body and functions as a protective barrier against physical, chemical, and microbial insults, while also contributing to thermoregulation, immune surveillance, and sensory perception.(Goswami et al., 2022) Dermatological disorders encompass a wide spectrum of conditions, including inflammatory, infectious, autoimmune, and neoplastic lesions.(Goswami et al., 2022; Adhikari et al., 2019) Many of these disorders present with overlapping clinical features, making accurate diagnosis based solely on clinical examination challenging and necessitating histopathological evaluation.(Goswami et al., 2022; Adhikari et al., 2019)

Skin biopsy followed by histopathological examination remains the gold standard for the diagnosis of skin diseases.(Goswami et al., 2022) Histopathology enables precise identification of inflammatory patterns, infectious organisms, and neoplastic changes, thereby facilitating accurate diagnosis and appropriate management.(Goswami et al., 2022; Adhikari et al., 2019) It also plays an essential role in distinguishing benign from malignant lesions and provides valuable prognostic information in neoplastic conditions.(Goswami et al., 2022; Adhikari et al., 2019)

Dermatopathology relies on the recognition of characteristic histological reaction patterns such as spongiotic, lichenoid, psoriasiform, vesiculobullous, granulomatous, and neoplastic patterns, which aid in narrowing the differential diagnosis.(Elder et al., 2018) Lever’s Histopathology of the Skin highlights the importance of correlating histopathological findings with clinical features to arrive at a definitive diagnosis.(Elder et al., 2018) Clinicopathological correlation is therefore essential in dermatology, as histopathology provides objective morphological evidence that complements clinical assessment.(Elder et al., 2018)

Non-neoplastic skin lesions constitute the majority of dermatological biopsies and include inflammatory dermatoses, autoimmune disorders, and infectious diseases.(Goswami et al., 2022; Adhikari et al., 2019) Infectious dermatoses, particularly Hansen’s disease, fungal infections, and viral infections, remain significant causes of morbidity in developing countries, including India.(Goswami et al., 2022; Adhikari et al., 2019) Histopathological examination is crucial in the diagnosis and classification of Hansen’s disease and plays an important role in guiding therapy.(Goswami et al., 2022)

Neoplastic lesions of the skin include benign tumors such as epidermoid cysts and melanocytic nevi, as well as malignant tumors such as basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.(Goswami et al., 2022; Adhikari et al., 2019) Although malignant lesions account for a smaller proportion of skin biopsies, early detection is essential because of their potential for local invasion and metastasis.(Goswami et al., 2022; Adhikari et al., 2019) Basal cell carcinoma and squamous cell carcinoma are the most common non-melanoma skin cancers worldwide.(Adhikari et al., 2019)

Several hospital-based studies from India have demonstrated that non-neoplastic lesions predominate in skin biopsy specimens, followed by benign and malignant neoplasms.(Goswami et al., 2022; Bezbaruah & Baruah, 2018;Singh et al., 2023) However, the frequency and pattern of dermatological lesions vary depending on geographic location, environmental factors, and population characteristics.(Goswami et al., 2022; Adhikari et al., 2019) Understanding the histopathological spectrum of skin lesions in a given region is important for improving diagnostic accuracy and guiding clinical management.(Goswami et al., 2022; Adhikari et al., 2019)

Therefore, the present study was undertaken to evaluate the histopathological spectrum of skin lesions in a tertiary care hospital and analyze their distribution with respect to age, sex, and pathological categories.

Study design and setting: Cross-sectional retrospective study conducted at the Department of Pathology, Shimoga Institute of Medical Sciences, Shivamogga.

Study period: December 2024 to December 2025.

Inclusion criteria: All skin punch biopsy and excision biopsy specimens received during the study period.

Processing: Specimens were fixed in 10% buffered formalin, processed routinely, paraffin-embedded, sectioned at 3–5 µm, and stained with hematoxylin and eosin. (Elder et al., 2018)

Definitions: Non-neoplastic lesions were categorized as infectious or non-infectious. Neoplastic lesions were classified as benign or malignant based on histopathological diagnosis. (Elder et al., 2018)

across all groups, with a peak in 46–60 years (Table 1).Non-neoplastic lesions predominated (n=284; 86.3%). Among them, non-infectious lesions were the major category (n=230; 69.9%), while infectious lesions accounted for 54 cases (16.4%) (Table 2)

Among infectious lesions, leprosy constituted the majority (lepromatous, borderline tuberculoid, tuberculoid and unspecified forms), followed by other infections such as molluscum contagiosum and fungal infections (Table 3).

Among non-infectious non-neoplastic lesions, psoriasiform and lichenoid disorders were frequent. Psoriasis (n=34) and lichen planus (n=20) were common, along with dermatitis/eczema and autoimmune blistering disorders (Table 4).

Neoplastic lesions comprised 45 cases (13.7%). Benign neoplasms were 21 cases (6.4%) and included epidermoid cysts as the most frequent benign lesion. Malignant neoplasms were 24 cases (7.3%), with basal cell carcinoma being the most common malignancy (Table 5).

TABLES

Table 1: Age and sex distribution of cases (n = 329)

Table 2: Category-wise distribution of skin lesions

Table 3: Type and frequency of infectious skin lesions (non-neoplastic) (n = 54)

Table 4: Type and frequency of non-infectious non-neoplastic skin lesions (n = 230)

Table 5: Type and frequency of neoplastic skin lesions (n = 45)

Figure 5: Chromoblastomycosis (H&E stain, ×400).
Photomicrograph shows hyperkeratosis and acanthosis of the epidermis with dermal granulomatous inflammation containing characteristic brown, thick-walled, round sclerotic (Medlar) bodies, also known as copper-

Figure 7: Squamous cell carcinoma (H&E, ×100).
Section shows invasive malignant squamous epithelial cells arranged in nests and islands with prominent keratin pearl formation, characteristic of well-differentiated squamous cell carcinoma.

 LIMITATIONS OF THE STUDY
The present study has certain limitations. First, it was a single-center hospital‑based study and therefore the findings may not represent the exact prevalence of dermatological diseases in the general population. Second, the retrospective nature of the study limited detailed clinical information and follow‑up data in some cases. Third, ancillary investigations such as special stains and immunohistochemistry were not performed in all cases, which might have further aided in characterization of certain lesions.

 Non-neoplastic lesions predominate among skin punch biopsies in a tertiary care setting. Infectious dermatoses—particularly leprosy—continue to contribute a significant burden. Psoriasis, lichen planus, and dermatitis/eczema are common non-infectious diagnoses. (Goswami et al., 2022; Adhikari et al., 2019). Although neoplastic lesions are less frequent, malignant tumors (especially basal cell carcinoma) are clinically important and highlight the value of early biopsy. Histopathological examination remains central to definitive diagnosis and management. (Singh et al., 2023)

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