Clinico-pathological study of Cutaneous Tumours of Head and Neck

INTRODUCTION : Skin is a complex and the largest organ in the body. Because of its complexity a wide range of diseases can develop from the skin including tumors from surface epidermis, epidermal appendages , dermal & subcutaneous tissue. The vast diversity of these lesions combined with a body of descriptive data, often overlapping (clinical, histological) produces confusion in the area of nomenclature and difficulty in diagnosis. Tumours of skin are histopathologically diverse group of entities which have common localized proliferation of cells resulting in clinically discrete lesions. They may be divided into a number of categories, reflecting their different biological behaviour. These include hamartomas, benign tumours, premalignant and malignant conditions. This study of tumours of skin has been undertaken to find out the frequency of benign and malignant growths. The study has been limited to the cases attending the Dermatology Department, Chengalpattu Government Hospital, Chengalpattu. Most of the tumours whether benign or malignant are symptomless but are cosmetically unacceptable. The distinction between benign and malignant neoplasm are rather more difficult to define when they appear in skin than when found elsewhere and histopathological examination is frequently required to establish a definitive diagnosis. Diagnosis of any skin tumors can be done by correlating clinical features and histological features, which can be supported by histochemistry, immunohistochemistry and electron microscopy. Thus, the study of skin tumors is perhaps more intriguing, fascinating, challenging and at times even frustrating than any other tumors. AIMS AND OBJECTIVES : To find out the 1. Overall frequency of skin tumours of head & neck reported in the out-patient department of dermatology, Chengalpattu Medical College , Chengalpattu. 2. Age & sex predominance of the various tumours encountered. 3. Different clinical presentation such as morphology, site and association with other skin & systemic conditions. 4. Histopathological features of the various tumours encountered. MATERIALS AND METHODS : 100 patients presenting with different forms of cutaneous tumours of head & neck as their main complaints were selected for the study from the skin department of Chengalpattu Government Hospital, Chengalpattu during the one year period from October 2008 to September 2009 at random. The provisional diagnosis were mainly made by clinical presentations. The age and sex of all the hundred cases along with their occupation were recorded. The duration of the skin lesions in all the patients was also noted. Specific and relevant histories were taken from certain cases with skin tumours and they included history of prolonged intake of any internal medication like inorganic arsenic containing preparation which may lead to basal cell epithelioma. Family history regarding the presence of tumours was also elicited and it was relevant in trichoepithelioma and steatocystoma multiplex. Menstrual, marital, parturition histories were taken in the female patients. History of medical and surgical intervention for the above complaints if any was also noted in all the 100 patients. Thorough clinical examination of the skin lesions was carried out in all the cases with special reference to the site, number, size, shape, color, surface, borders, consistency, tenderness and compressibility of the lesions. Whether the lesions were grouped or discrete, sessile, or pedunculated or whether there were any attachment to the underlying structures or the overlying skin were also observed. Careful general and systemic examinations were carried out. Investigations like complete haemogram, blood sugar, renal function test, VDRL, HIV status and skin biopsy in the form of both excision and incision biopsy were carried out. The sections for histopathological examination were stained with haematoxylin and eosin and studied in both low and high power magnifications. In selected cases, X-ray skull, Barium meal study, Barium enema, Upper GI–Endoscopy, ultrasonogram were carried out. Most of the patients were treated surgically in the form of complete excision of the lesions. Few cases were treated with electrocautery & cryotherapy. CONCLUSIONS : A study of clinicopathological features of tumours of head & neck was done on 100 patients at random over a period of one year from October 2008 to September 2009 attending the outpatient department of skin & STD, Chengalpattu Medical College, Chengalpattu. 1. The commonest skin tumours recorded were surface tumors of Epidermis (62%) followed by tumours of epidermal appendages (21%), tumours of neural tissue (8%), other tumours constitutes (9%). 2. Majority of the patients reported with the skin tumours of head and Neck were adults. The tumours such as epidermal nevus, nevus sebaceous, neurofibroma occur in childhood (23 %) and these need awareness among the parents to bring the children at an early age. 3. The highest age incidence observed in this study was in the fifth decade (21%) followed by sixth decade (20%). 4. The reporting of the skin tumours was more by the females (54 %) compared to males (46 %) probably because of their cosmetic awareness. 5. The commonest tumour encountered in this study was Acrochordons (15%) with classical histopathology. 6. The second common tumour was seborrheoic keratosis (14%). All the patients had their lesions in the sun exposed areas like face & neck except one male & one female who had multiple lesions all over the body and having classical histopathology. 7. Epidermal cyst and syringoma (12 %) were the third most common tumour encountered in this study and with classical histopathology. 8. Neurofibroma (8%), Basal cell carcinoma (7%), Epidermal nevus (6%), squamous cell carcinoma(5%), trichoepithelioma (5 % ), pyogenic granuloma (4%), nevus sebaceous ( 3%) , steatocystoma multiplex (3% ), keloid (3%), angiofibroma (2%) were also encountered in our study with classical clinical and histopathological findings. 9. Rare case like xeroderma pigmentosum with squamous cell carcinoma was encountered in a female child. 10. In this study, among 15 patients with acrochordons, 6 (40%) had diabetes Mellitus. 11. Familial occurrence were noted in 2 cases of syringoma, 2 cases of steatocystoma multiplex and one case of keloid