The human body's largest organ, the skin, can develop a variety of lesions in reaction to both internal & external stimuli. Histopathological analysis is frequently required for a conclusive diagnosis due to the clinical overlap across dermatological disorders [1].

Skin biopsies are crucial for establishing the stage of the disease, diagnosing early malignancy, & directing treatment in addition to validating clinical impressions.

The objective of this study is to examine the distribution, frequency, & histological spectrum of skin lesions in a cohort of 100 individuals by age & sex [2].

The superficial lining epithelium is found in the epidermis. Blood vessels, sweat glands, sebaceous glands, loose areolar tissue, & hair follicle roots are all found in the dermis. Adipose tissue makes up the majority of the hypodermis. The skin has vital roles to play in metabolism, temperature regulation, & protection. Patients with skin conditions make up a sizable portion of outpatients & account for a higher percentage of hospital cases [3].

Numerous elements, including the climate, economy, literacy, geography, ethnic groupings, genetics, & social practices, all have an impact on skin diseases. Skin conditions can sometimes be the only sign of a systemic illness [4]. Clinical appearance & history can be used to diagnose many skin lesions. In most situations, however, a skin sample is necessary for the histological analysis of the skin lesions. Skin biopsies can be obtained using a variety of techniques, such as curettage, scalpel, incisional, excisional, punch, & shave biopsy. A biopsy of the skin lesion using any of the previously described techniques, followed by a histological analysis, confirms the lesion's diagnosis & facilitates therapy.

A large range of skin illnesses can be seen in their histomorphology, but only a small number of them have clinical manifestations, such as hypopigmentation, hyperpigmentation, macules, papules, nodules, & a few others [5]. Since different skin conditions that appear with similar clinical symptoms have distinct treatments, it is crucial to diagnose skin illnesses accurately.a

A prospective observational study was carried out in the Department of Pathology at People's College of Medical Sciences & Research Centre, Bhopal over 12 months.

Inclusion Criteria

• All skin biopsies received during the study period with adequate clinical data.
• Patients of all age groups & both sexes.

Exclusion Criteria

• Poorly preserved or inadequate biopsy specimens.
• Lesions with uncertain diagnosis even after routine staining.

Procedure

Skin biopsies were fixed in 10% formalin, processed, embedded in paraffin, sectioned at 4–5 μm, & stained with Hematoxylin & Eosin (H&E).
Special stains (PAS, Ziehl–Neelsen, etc.) were applied where indicated.

Data Analysis

Cases were categorized as:

1. Non-neoplastic lesions
2. Benign neoplastic lesions
3. Malignant neoplastic lesions

Descriptive statistics were applied to determine frequency & percentage distributions

Table 1: Distribution of Skin Lesions by Diagnostic Category (n = 100)

Table 2: Age & Sex Distribution of Skin Lesions

Table 3: Spectrum of Non-Neoplastic Skin Lesions (n = 58)

Table 4: Spectrum of Neoplastic Skin Lesions (n = 42)

According to comparable regional research, non-neoplastic dermatoses were the most common in this study (58%). According to Sharma et al. (2020), psoriasis was the most common non-neoplastic lesion.

Seborrheic keratosis was the most common benign neoplasm, accounting for 28% of the total, which is indicative of its high prevalence in older people as a result of prolonged sun exposure [6].

According to findings similar studies, malignant lesions accounted for 14% of cases, with squamous cell carcinoma being the most prevalent & followed by basal cell carcinoma.

A small male predominance was indicated by the male-to-female ratio of 1.08:1, which may have been caused by environmental variables & increased occupational exposure to sunlight [7].

The clinical & histological spectrum of skin lesions is broad & diverse. The gold standard method for identifying skin lesions is histopathological analysis of the skin biopsy. A straightforward outpatient technique called a skin biopsy aids in the clinical diagnosis's confirmation.

Nearly all patients with pemphigus vulgaris have mucosal lesions at some stage of the illness, & 50–70% of patients first present with oral lesions. It is possible for mucosal lesions to be the only indication of the disease for several months before skin lesions appear [8–10]. Any patient with chronic oral erosive lesions & a positive Nikolsky sign should have pemphigus vulgaris diagnosed.

It is necessary to prepare Tzanck smears from new bullous lesions. When assessing blistering diseases, the Tzanck smear is a crucial diagnostic tool. It is most frequently used to differentiate non-viral conditions from viral ones, including varicella, herpes zoster, & herpes simplex [11–13]. It is crucial to remember that multinucleated large cells are not seen in Tzanck smears from smallpox & vaccinia vesicles. To obtain the smear, use a curved scalpel blade or scissors to remove the blister's "roof," then scrape the base to collect the moist, hazy debris. Giemsa or Wright stain is then applied after the material has been spread out onto a glass slide & allowed to air dry. Multinucleated giant cells are a diagnostic feature of viral blisters. The enormous cell is significantly bigger than typical inflammatory cells & is a syncytium of epidermal cells with several overlapping nuclei. Many epidermal cells stacked on top of one another could be mistaken for a big cell.

Histopathological examination plays a crucial role in the accurate diagnosis & classification of skin lesions. Non-neoplastic conditions form the bulk of dermatopathological cases, but the significance of identifying malignant lesions early cannot be overstated. Regular clinicopathological correlation enhances diagnostic accuracy & patient outcomes.

1. Gupta A, et al. Clinicopathological correlation of skin tumors: A hospital-based study. J Clin Diagn Res. 2021;15(4):EC05–EC09.
2. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease, 10th ed. Elsevier; 2020.
3. Singh N, et al. Histopathological study of non-neoplastic skin lesions. Int J Res Med Sci. 2019;7(5):1802–1806.
4. Gaikwad SL, Kumawat UD, Sakhare NA, et al. Histopathological spectrum of skin lesions- experience at rural based hospital. Int J Cur Res 2016;8(8):36223- 36227.
5. Gulia SP, Wadhai SA, Lavanya M, et al. Histopathological pattern of skin diseases in a teaching hospital Puducherry. Int J Recent Trend Sci Technol 2014;11:45-50.
6. Sharma P, et al. Histopathological spectrum of skin lesions: A study of 120 cases. Indian J Pathol Dermatol. 2020;6(2):85–90.
7. Goyal N, Jain P, Malik R, et al. Spectrum of nonneoplastic skin diseases: a histopathology based clinicopathological correlation study. Sch J App Med Sci 2015;3(1F):444-449.
8. Elder DE, Elenitsas R, Rosenbach M, et al. Outline of skin disease. Chap- 5. In: Lever’s histopathology of the skin. 11th edn. Lippincott Williams & Wilkins 2014:127-129.
9. Singh S, Debnath A, Datta D, et al. Histopathological evaluation of skin lesions with special reference to skin adnexal tumors in a tertiary centre of north-eastern india- a three year study. IOSR Journal of Dental & Medical Sciences (IOSR-JDMS) 2016;15(2):34-39.
10. Bansal M, Sharma HB, Kumar N, et al. Spectrum of skin lesions including skin adnexal tumors in a North Indian tertiary care hospital. IP Journal of Diagnostic Pathology & Oncology 2019;4(1):67-71.
11. Adhikari RC, Shah M, Jha AK. Histopathological spectrum of skin diseases in a tertiary skin health & referral centre. Journal of Pathology of Nepal 2019;9(1):1434-1440.
12. Bezbaruah R, Baruah M. Histopathological spectrum of skin lesions- a hospital based study. Indian Journal of Applied Research 2018;8(7):51-52.
13. Dayal SG, Gupta GD. A cross section of skin diseases in Bundelkhand region, UP. Indian J Dermatol Venereol Leprol 1977;43(5):258-261.