HISTOPATHOLOGICAL EVALUATION OF CHRONIC NON HEALING ULCERS OF SKIN IN PATIENTS REFERRED TO TERTIARY CARE HOSPITAL IN KASHMIR

Background: Skin is the single largest organ of the body that protects against mechanical trauma, radiation and infection. Because of its complexity a wide range of diseases can develop from the skin ranging from infectious diseases to malignancy, some of which may present as non-healing ulcers. Non healing ulcers are an important cause of morbidity in developing countries. Study of non-healing skin ulcers is challenging and at times even frustrating than any other skin lesions. This study was taken keeping in view the present scenario were patient with non-healing ulcers go unnoticed for a long time without biopsy resulting in uncertainty of developing malignancy which can otherwise be identified at a very early stage by early histopathological examination. Aim: Aim of this study was to study the histopathological outcome of non-healing ulcers in this geographical area where much is not known about the etiology of non-healing ulcers. Methodology: This study was hospital based two years prospective study extending from January 2016 to December 2017 conducted in Department of Pathology, Government Medical College Srinagar. During this period patients referred from peripheral hospitals with ulcers that had not healed for 4 weeks or more after conventional therapies were included in this study. The detailed history and clinical examination findings were retrieved from the case files. Biopsies received were processed as per the standard protocol and slides were examined by the senior pathologist in the Department of Pathology, Government Medical College Srinagar. Results: During the two years period department received biopsies from 282 patients with non-healing ulcers. Out of 282 patients 180 were males and 102 were females with a M:F ratio of 1.76:1. 0ut of the 282 cases 100 (35.46%) were diagnosed as malignant ulcers and 182(64.54%) were diagnosed as benign ulcers (Table 1). Out of the 282 cases, 70 cases (24.82%) were found to be neuropathic diabetic ulcers, 52 (18.43%) were diagnosed as tubercular ulcers, 44 (15.60%) as infectious, 4 (1.42%) as leprosy, 4 (1.42%) cases were due to parasitic infection (cutaneous leishmaniasis) and 8 cases (2.83%) as others. Benign ulcers were found to be fairly common below 50 years of age. Lupus Vulgaris was found to be the commonest form among the tubercular ulcers constituting 75% of the tubercular ulcers followed by Scrofuloderma accounting for 25% of the cases. Among malignant cases, that Squamous cell carcinoma is the most common variety of malignancy encountered in an ulcer accounting for 82% of cases followed by Basal cell carcinoma 14% and malignant melanoma 4%. Conclusion: Non-healing ulcers can be encountered at any age and etiology may vary from one geographical region to other and may also be different in different racial groups. Thus beside a good clinical diagnosis, early biopsy to rule out malignancy and identify the etiology is mandatory for a better outcome and minimize the morbidity and mortality among patients with non-healing ulcers.