Clinico-dermoscopic and Histopathological Evaluation of Benign Skin, Soft Tissue and Appendageal Tumours of Skin: A Cross-sectional Study from a Tertiary Care Hospital

Abstract

Background: Benign skin, soft tissue and appendageal tumours of skin are one of the most frequently encountered skin disorders. An organised systematic approach along with dermoscopic and histopathological examination can aid in the diagnosis of these diverse disorders.

Objective: To evaluate clinico-dermoscopic and histopathological findings of benign skin, soft tissue and appendageal tumours of skin in patients attending a tertiary care hospital.

Methods: Cross-sectional hospital-based study where patients of all age groups irrespective of gender suspected of having benign skin, soft tissue and appendageal tumours were enrolled. Clinical, dermoscopic and histopathological findings were recorded and the agreements between them were evaluated using the Cohen's Kappa coefficient.

Results: The study included a total of 415 patients with a mean age of 37.9 ± 15.59 years and a male to female ratio of 1:1.3. The mean duration of the disease was 4.3 ± 2.14 years. Soft tissue tumours were the commonest (60%), followed by benign skin tumours (24.3%) and benign appendageal tumours (17.1%). A good agreement between dermoscopic and clinical diagnosis was found (Cohen's Kappa = 0.879) and between dermoscopic and histopathological diagnosis was also found (Cohen's Kappa = 0.789).

Conclusion: This study infers that benign tumours of the skin include a heterogeneous group of skin disorders affecting a heterogeneous population. Dermoscopy improved the diagnostic accuracy of this large group of skin disorders and reduced the number of unnecessary excisions; however, histopathology remains the benchmark diagnostic tool to differentiate these tumours from other benign tumours and their malignant counterparts.

Keywords: Benign; dermoscopy; histopathology; tumours.

Figure 1

a, b: Brown to grey structureless area (yellow arrow). (Polarised, Dermlite DL4, 3 Gen, 10×). c: Hyperkeratotic and acanthotic lining epidermis, basal layer pigmentation (black arrow), dermis comprising of loose fibrovascular stroma (red arrowhead) and dilated lymphatic vessels (black circle).(H&E, 40×). d: Peripheral pigment network (yellow arrow) and central white scar like patch (black arrow). (Polarized, Dermlite DL4, 10×) with Dimple/Fitzpatrick sign in inset. e: Peripheral pigment network (yellow arrow) and central white scar like patch (black arrow). (Polarized, Dermlite DL4, 10×). f: Predominance of fibroblasts (black circle) and collagen bundles and grenz zone (red triangle). (H&E, 40×)

Figure 2

a: Pink homogenous area with white rail lines (black arrow). (Polarized, Dermlite DL4, 10×). b: Pink homogenous area and white collarette (blue arowhead). c: Hyperplastic epidermis (black arrow), dermal lobular proliferation of capillary vessels (red circle) in a loose and edematous stroma and an infiltrate of neutrophils, lymphocytes and plasma cells (yellow star). (H&E, 40×). d, e: Pink homogenous area, finger print like structures (green stars), white areas (red arrow) and arborising vessels (yellow arrow). (Polarized, Dermlite DL4, 10×). f: Proliferation of serpentine spindle cells (red arrow), shredded collagen (black arrow) and dilated capillaries (black circle). (H&E, 40×)

Figure 3

a: Milia-like openings (black circle), comedo-like openings (black arrowhead) and sharp demarcation (black arrow). (Polarized, Dermlite DL4, 10×). b: Parched paddy field appearance of Seborrhoeic keratosis. c: Hyperkeratosis (black arrow), basaloid cell proliferation without atypia (red arrow) and psuedohorn cysts (yellow circle). (H&E, 40×). d, e: Structureless white area with residual globular pattern (red arrowhead), terminal hairs and unfocused linear vessels (yellow arrow) and focused linear vessels. (Polarized, Dermlite DL4, 10×). f: Melanocytic nests in dermis (black circles).(H&E, 40×)

Figure 4

a. Compound nevus showing cobblestone pattern (black arrow). (Polarized, Dermlite DL4, 10×). b. Multifocal white dots (yellow arrow) and brown pigment network (red arrow). (Polarized, Dermlite DL4, 10×). c. Nevomelanocytic nests at dermoepidermal junction as well as in dermis. (H&E, 40 × d. Brown homogenous area, whitish scales (yellow star) and starburst pattern (yellow circle). (Polarized, Dermlite DL4, 10×). e. Pink homogenous area with chrysalis-like pattern (blue arrow), linear vessel (green arrow). (Polarized, Dermlite DL4, 10×). f. Hypergranulosis (red arrowhead), melanin deposits in epidermis and dermis (black circle), mild mitosis (green arrow) and lymphocytic infiltrate in dermis (black arrow). Nests of melanocytes are perpendicular to the epidermis. (H&E, 40×)

Figure 5

a: Ivory-white homogenous area with irregular and poorly defined borders (black circle) and multifocal dots (black arrowhead). (Polarised, Dermlite DL4; 10x). b: Well-defined Ivory white homogenous area. (Polarised, Dermlite DL4; 10x). c: Cords and tubules lined by double layers of bland, monomorphic, cuboidal cells with small inconspicious nuclei and small amount of pale eosinophilic cytoplasm (Square) (H&E, 40×). d: Lacunae like areas, blue-grey area (yellow arrow) and cherry blossom vessels (vessels with circular and semicircular tips) (black circles). (Polarized, Dermlite DL4;10x). e: Poroma cells (monomorphic, cuboidal cells with basophilic round nuclei, inconspicious nucleoli and compact eosinophilic cytoplasm) and well-formed duct (circle). (H&E, 40×). f: Sebaceous hyperplasia showing yellowish globules (clods) (black arrow) with crown vessels (blue arrow) not crossing the midline. (Polarized, Dermlite DL4; 3 Gen, 10x)