The Clinicohistopathological of Skin Tumors in Dr. M. Djamil

Hospital and Pathology Anatomy Departement, Medical Faculty of

Andalas University Padang during 2014-2017

Fesdia Sari

, Sri Lestari, Ennesta Asri

, Nadya Hasriningrum

Dermato-Venereology Department of Dr. M Djamil Hospital/

Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia

Keywords: Skin tumor, benign skin tumor, malignant skin tumor, histopthology.

Abstract: Skin tumors may be encountered by a dermatologist either as presenting complaints or as incidental findings.

Certain tumors are easily recognized clinically, while others must confirmed by histopathology. In Indonesia,

there has been less data about skin tumors. The aim of this study to evaluate characteristics and

histopathological of skin tumors in Dr. M. Djamil Hospital and Pathology Anatomy Department, Medical

Faculty of Andalas University during 2014-2017. A retrospective study from medical record of Dr. M. Djamil

Hospital Padang and Pathology Anatomy Departement, Medical Faculty of Andalas University during 2014-

2017. Data was collected from medical record during 2014-2017. Variables studied were, age, sex, and

histopathology of the tumors. Benign skin tumor was 72,09% and malignant skin tumor was 27,91%. Male

were affected 49,2% and female were 50,8 % in benign skin tumors, but in malignant skin tumors male were

affected 51,45% and female 48,55%. Benign skin tumors most common on 30-60 years old (45,86%),

followed by <30 years old (30,83%) and >60 years old (23,31%). However, malignant skin tumors most

common >60 years old (69,9%), and rare on <30 years old (1,94%). All of malignant skin tumors were done

the histopathology examination, but only 51,8% in benign skin tumors. Skin tumors are common tumor in Dr.

M. Djamil Hospital Padang and Pathology Anatomy Departement, Medical Faculty of Andalas University.

The feature of skin tumors appear nearly similar to international figures with a low incidence of melanositic

skin tumors.

1 INTRODUCTION

The skin is a heterogenous organ with varied

elements having ectodermal and mesodermal origins.

Most of these individual elements are capable of

producing skin tumors (Chatra and Bhat, 2016).

Based on their origin, they can be devided into the

following: keratinocytic tumors, melanocytics tumor,

appendageal tumors, soft tissue tumors. Therefore,

the number of different skin tumors exceeds that any

organ system (Haroun et al., 2013).

Benign skin tumors such as syringoma, skin tags

are commonly encountered by a dermatologist and

are almost considered to be physiological in the

elderly (Haroun et al., 2013). Although not as

frequent, the incidence of basal cell carcinoma (BCC)

and squamous cell carcinoma (SCC) is increasing

worldwide, Caucasians being the primary victims.

However, everyone, regardless of skin color, can fall

prey to it. Unfortunately, many patients and even

some physicians are under the impression that non

Caucasian people are immune to this disease (Al-

Maghrabi et al., 2014). That is one reason, people of

color are diagnosed with skin cancer at later stages.

These delays mean that skin cancers are often

advanced and potentially fatal, whereas most skin

cancers are curable if caught and treated in a timely

manner (Baldwin and Dunn et al., 2013). These

tumors can show an extraordinary variation in their

structure, and it is this variation that causes

difficulties in some cases in establishing a definitive

pathological diagnosis (Alwunais and Ahmad, 2016).

The aid of histopathology is crucial in clinching the

right diagnosis and in further management.

Traditionally, smaller lesions have been the domain

of dermatologists, while the larger and deeper masses

were considered a surgeon’s forte. Malignant lesions,

even when small, have been referred to the surgeon

for management. Nevertheless, the role of a

dermatologist is rapidly expanding in many

Sari, F., Lestari, S., Asri, E. and Hasriningrum, N.

The Clinicohistopathological of Skin Tumors in Dr. M. Djamil Hospital and Pathology Anatomy Departement, Medical Faculty of Andalas University Padang during 2014-2017.

DOI: 10.5220/0008155002490252

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 249-252

ISBN: 978-989-758-494-7

249

disciplines, management of skin tumors being one of

them (Hussein, 2005).

2 MATERIALS AND METHODS

A retrospective study was conducted on all of skin

tumor cases diagnosed during the period 2014-2017.

Data were collected from medical record during

2014-2017. Variables studied were, age, sex, site, and

histology of the tumor. We exclude all data that did

not include any of the above variables.

3 RESULTS

Table 1 show two hundred and sixty six benign skin

tumor patients were studied during the period 2014-

2017. One hundred and thirty one (49,2%) were

males and one hundred and thirty five (50,8 %) were

females. During 2014-2017 the patient <30 years old

were eighty two (30,83%), 30-60 years old were one

hundred and twenty two (45,86%) and >60 years old

were sixty two (23,31%). Histopathology

examination were done from benign skin tumors one

hundred and thirty eight (51,8%) as seen in Table 1.

Table. 2 show one hundred and three malignant

skin tumor patients were studied during the period

2014-2017. Fifty three patients (51,45%) were males

and fifty patients (48,55 %) were females. During

2014-2017 the patient <30 years old were two

(1,94%), 30-60 years old were twenty nine (28,15%)

and >60 years old were seventy two (69,9%) . All of

the malignant skin tumors do the histopathology

examination, as seen in Table 2.

4 DISCUSSION

Most of the tumors were easily recognizable

clinically, hence, in these cases, histopathology was

just a tool to confirm the diagnosis. However, a few

cases had dubious clinical appearance and required

clinicopathological correlation.

In this study we

found 226 cases of benign skin tumor and 103 cases

of malignant skin tumor. Among the benign skin

tumor only 51,8% confirm with histopathology, but

all of malignant skin tumors confirmed with

histopathology examination. Seborrheic keratosis

were the most benign skin tumor, followed by

pigmented nevi. Chathra et all, India 2016 reported

seborheic keratosis was the most common skin tumor

from keratinocytic origin (Chatra and Bhat, 2016).

In this study sebaceous nevus is the most common

appendegeal skin tumor, followed by

trichoepitelioma and syringoma. Das N, India 2016

reported syringoma and trichoepitelioma were the

common skin appendegeal skin tumors. Most of the

patients presented to us were not even aware of the

disease because of their asymptomatic and benign

nature. Majority of the appendageal tumors were

diagnosed after long duration of their presence

(>10years), yet there was hardly any effect on

prognosis. In rest of the patients, the main concern of

coming and seeking treatment was cosmetic

disfigurement as the facial involvement was most

frequent (Das et al., 2011).

Haroun et al, Iraq 2013 reported skin cancer

accounts for 4,7% of all new cancer cases in Basrah

during 2005 to 2009.

The mean age of skin cancer

cases was 54,8+18,4 years (for males 55,2+17,8 and

for females 54,4+19,0).

Maghrabi et al, Saudia

Arabia 2004 reported the mean age of skin cancer was

62,2 years old and 58.75 years old in Pakistan.

Another study reported from Western and Asian

countries skin cancer appears rare before 30 years.

our study, the most affected age groups in this study

was beetwen >30-≤60 years of old (67.96%) and rare

on ≤ 30 years old. Our country located in khatulistiwa

region, it makes sun exposure more higher, and it can

make incidence of skin tumor more younger in our

departement.

Baldwin and Dunn, Korea 2013 reported the

incidence rate of skin cancer increases, it is unlike

many cancers can be prevented with a range of

personal and environmental life style factors,

including the use of personal protective clothing, hats

and sunglasses along with a sunscreen applied

correctly and the use of environmental

adaptations to

the outdoor environment such as shade (Baldwin and

Dunn, 2013). This study provides further baseline

information about skin cancer in this region of

Padang. In this study, skin cancer appears more in

females and male. Hussein, 2005 were found opposite

figures with higher male:female ratio of 1.6:1 in

Egypt. In our country, women in rural areas are

working outdoors in farming and animal herding.

This might explain female’s higher incidence of skin

cancer. Furthermore, women

in rural area mostly fair

skinned than males and unaware about protective

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

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Table 1. Demographic characteristic of benign skin tumors

Benign skin tumor Sex Age (years old) Histopathology

Male Female <30 30-60 >60 Yes No

Seborrheic keratosis 43 36 4 36 39 27 52

Epidermal cyst 1 1 1

Syringoma 1 11 3 8 1 3 9

Trichoepitelioma 2 11 13 13

Steatocystoma 5 1 6 6

Sebaseous nevus 14 6 6 14 6 14

Spilus nevus 1 1 1

Becker’s nevus 2 1 1 2

Dermoid cyst 5 3 1 6 1 5 3

Sebaseous hyperplasia 4 5 9 5 4

Melanositic nevi 14 18 17 14 1 14 18

Senilis lentigo 3 3 6 6

Lipoma 8 1 1 4 4 8 1

Xanthoma 4 8 2 7 3 11 1

Xanthelasma 5 5 5

Pyogenic granuloma 3 1 3 1 4

Neurofibroma 1 9 7 3 8 2

Fibro mole 14 12 2 18 6 13 13

Angiofibroma 7 3 7 2 1 10

CTCL 1 1 1

Total 131 135 82 122 62 138 128

Table 2. Demographic characteristic of malignant skin tumors

Malignant skin tumor Sex Age (years old) Histopathology

Male Female <30 30-60 >60 Yes No

Basal cell carcinoma 26 33 11 48 56

Basosquamouscell carcinoma 4 6 4 6 10

Squamous cell carcinoma 17 6 1 8 14 23

Melanoma maligna 6 5 1 6 4 10

Total 53 50 2 29 72 103

measures such as sun screen creams (Alwunais and

Ahmad, 2016; Hussein, 2005).

It is well documented that non melanoma and

melanoma skin cancer is sun exposed injury. In the

present study, the most common histological type was

Basal cell carcinoma (57,28%) which was also the

most common skin cancer in females, whereas

Squamous cell carcinoma was (22.33%). Similarly,

Basal cell carcinoma is the most common skin cancer

in Bahrain, Saudi Arabia, Egypt, and Iran.

6,8,9

It is

also a commonest cancer in Asia and Europe. Basal

cell carcinoma is the most common form of skin

cancer, corresponding to around 75% of malignant

skin tumors. Chronic sun exposure which differs

between men and women is believed to be the

principal cause of these lesions. In our country,

majority of people living in rural areas and expose to

sun for long time per year and large fraction of the

people are farmer, fisherman that had long period sun

exposed (Armstrong and Kricker, 2001). Squamous

cell carcinoma is the second skin cancer in this study

(22.33%) and it also appears as the second skin cancer

of adjacent Arab countries, 53.3% in Egypt, 31.1% in

Bahrain, 47% in Saudi Arabia, 42.6% in Sudan

population, and 26.4% in Jordan (Hussein, 2005;

Doherty et al., 2010, Diepgen and Mahler, 2002). On

the other hand, Squamous cell carcinoma is the

commonest skin cancer in Sudan (42.6%) and it

represents 53.6 % in comparison to Basal cell

carcinoma 40% in Pakistan. These reverse figures

may be related to different etiological factors in

Sudan and Pakistan (Haroun et al., 2013).

In this study, melanotic skin cancer was a rare skin

cancer. It represented 10,67 % of all skin cancer and

The Clinicohistopathological of Skin Tumors in Dr. M. Djamil Hospital and Pathology Anatomy Departement, Medical Faculty of Andalas

University Padang during 2014-2017

251

it almost comparable figure was seen in Egyptian

population where melanotic skin cancer represents

8% of skin cancer with male preponderance (Hussein,

2005). Melanotic skin cancer constituted 2.5% of all

skin cancer in Iran with male predominance (Chatra

and Bhat, 2016). The highest incidence rate of

cutaneous melanoma maligna was seen in Australia

which reach up 50 new cases per/100.000. Melanoma

incidence is inversely proportional to darkness of

skin. Fairer-skinned Singaporeans of Chinese origin

have a higher incidence of melanoma (0.5/100,000)

than darker-skinned Indian Singaporeans

(0.2/100,000), and white South Africans have a

greater incidence of melanoma than those with mixed

ancestry and then black South Africans (Baldwin and

Dunn, 2013).

Most people in our country are of dark skin which

make them more protected from UVR and with low

incidence of melanoma. Melanotic skin cancer in

darker-skinned people presents in different anatomic

locations than in lighter colored people with a greater

proportion of acral melanoma and melanoma

presenting in non-sun-exposed areas.

5 CONCLUSIONS

Skin tumor is a common tumor in patients living in

Padang. The pattern of skin tumor appears nearly

similar to the international figures with low incidence

of MSC. Regardless how common skin tumor in

Padang, these information indicates the need of

specific and comprehensive health care and

epidemiological studies to investigate skin tumor

community related risk factors in Padang and to

implement a public strategy for prevention and

control.

ACKNOWLEDGEMENTS

This study was not sponsored and there are no

conflicts of interest.

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