THE DUAL LENS – DERMATOLOGICAL AND HISTOPATHOLOGICAL PERSPECTIVES IN SKIN MALIGNANCIES

Abstract

Background:
Cutaneous malignancies encompass a diverse range of neoplasms with varied clinical presentations and biological behaviours. While clinical evaluation is the first step in identifying these lesions, histopathology remains the gold standard for definitive diagnosis. This study assesses the correlation between clinical dermatological diagnosis and histopathological findings in suspected malignant skin lesions.

Materials & Methods:

A prospective observational study was conducted over one year (March 2024–February 2025) on 70 patients with clinically suspected malignant skin lesions. Clinical diagnosis was based on lesion morphology, distribution, and patient history. Incisional or excisional biopsies were processed and stained with haematoxylin and eosin for histopathological evaluation. The concordance between clinical and histopathological diagnosis was calculated, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.

Results:
Among 70 patients, 44 (62.9%) were male and 26 (37.1%) female, with a mean age of 59.4 ± 13.2 years. The most common clinical suspicion was squamous cell carcinoma (SCC) in 28 cases (40%), followed by basal cell carcinoma (BCC) in 25 (35.7%), malignant melanoma in 9 (12.9%), and other rare malignancies in 8 (11.4%). Histopathology confirmed SCC in 26 cases, BCC in 24, malignant melanoma in 8, and revealed rare malignancies such as sebaceous carcinoma (3), dermatofibrosarcoma protuberans (2), and cutaneous lymphoma (3). Overall clinicopathological concordance was 91.4%. Sensitivity and specificity for clinical diagnosis of SCC were 92.8% and 96.8% respectively, while for BCC they were 96% and 98.1%.

Conclusion:
Clinical diagnosis shows high accuracy for common skin malignancies, particularly SCC and BCC, in the Indian context. However, rare tumours often mimic more common lesions, underscoring the indispensability of histopathology for definitive diagnosis.