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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. ANNEXURE – II. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. NAME OF THE CANDIDATE AND : Dr. SHASHIKUMAR. S .D ADDRESS POST GRADUATE IN PATHOLOGY, DEPARTMENT OF PATHOLOGY, MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE - 570 001. 2. NAME OF THE INSTITUTION : MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE. 3. COURSE OF STUDY AND SUBJECT : M. D. PATHOLOGY. 4. DATE OF ADMISSION TO THE COURSE : 5. TITLE OF THE TOPIC : “HISTOPATHOLOGICAL STUDY OF NEOPLASTIC LESIONS OF SKIN AND ADNEXAE” 14-08-2012 6. BRIEF RESUME OF THE INTENDED WORK: 6.1 NEED FOR THE STUDY: Histopathological study of neoplastic lesions of skin and adnexae plays an important part in dermatopathology .The need for the histopathological study is very essential in differentiating the tumors into benign, premalignant and malignant categories .Tumor and tumor like lesions arise from different components of skin such as surface epithelium, epidermal appendages and dermis. They pose a diagnostic challenge because of their morphologic overlap 1 and biological heterogeneity. The study is undertaken to study the various histopathological features in skin and adnexal tumors with respect to age, sex and site. Benign and malignant tumors if diagnosed early and treated have a higher rate of cure. The present study is primarily aimed at achieving early diagnosis with special emphasis on diagnosis of premalignant conditions. Skin cancers are relatively uncommon malignancies worldwide. There has been a progressive increase in the incidence of skin cancers since a decade. Three most frequent primary skin cancers are basal cell carcinoma, squamous cell carcinoma and malignant melanoma. In India, skin cancers constitute about 1 -2% of all diagnosed cancers. Sqamous cell carcinoma is the commonest form of skin cancer. The overall incidence of skin cancer varies from 0.5 to 2 per 1 lakh population. 6.2 REVIEW OF LITERATURE: A population based skin cancer screening intervention was conducted in the German state of Schelswig-Holstein. In this study, 15983 skin excisions were performed. A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 cases of malignant melanomas, 1961 cases of Basal cell carcinoma, 392 cases of Sqamous cell carcinoma and 165 other malignant tu mors were diagnosed. 1 A retrospective study was conducted at the Department of Pathology S.S.I Medical Sciences, Davangere for clinicopathological evaluation of Non Melanoma Skin Cancer [NMSCs], 60 were histologically categorized as skin malignancy, of which 31 were NMSC. Squamous cell carcinoma was the most common NMSC, constituting 26 cases and Basal cell carcinoma which constituted 5cases. NMSCs are often associated with greater morbidity, thus necessitating increased efforts to assess risk factors in individuals. 2 A retrospective study of clinicopathological features of eyelid skin tumor s was conducted at Ophtalmique Jules Gonin, Lausanne, Switzerland. In this study , 2 5504 eyelid skin tumors were studied in which benign tumors predominated over malignant ones. The 5 most frequent subtypes were Squamous cell papilloma, seborrheic keratosis, melanocytic nevus, hidrocystoma and xanthoma. Basal cell carcinoma was the most frequent malignant tumor, followed by squamous cell carcinoma and sebaceous carcinoma. 3 In a retrospective study of Appendageal Skin Tumors conducted at College Hospital, Trivandrum , which 10(30.30%) were males and Medical thirty three patients were analyzed, out of 23(69.70%) were females. Of these, Eccrine tumors were the commonest. Face was the commonest site to be affected (25 cases) followed by the scalp (24 cases). Appendageal skin tumors are relatively uncommon. Histopathology was found to be mandatory for diagnosis. 4 A retrospective study was conducted at Laboratoire d’ Histopathologie Cutanee, Strasbourg, France where 13457 cases of Basal cell carcinoma (BCC) were studied. Of these BCCs, 78.7% were nodular, 15.1% superficial and 6.2% morphoeiform .Nodular and morphoeiform types predominated in the head. The Superficial type was found on the trunk. 5 A study was conducted on histopathological sections from 24 patients with malignant melanoma of the eyelid skin. It was concluded that, nodular melanoma patients with lesion in the lid margins had a worse prognosis than those with the lesions on the eyelid skin. More than half of the tumors were located on the eyelid margin. 6 In another study which was conducted by Department of Laboratory Med icine and Pathology, Minnesota, 14 cases of Eccrine carcinoma were studied which included 5 males and 9 females. Ductal Eccrine carcinoma was found in 10 cases, eccrine porocarcinoma in 1 and mucinous carcinoma in 3 cases. Four patients with ductal eccrine carcinoma suffered metastasis and a 50% mortality rate was observed among this group of 10 cases. 7 3 6.3 OBJECTIVES OF THE STUDY: To study histomorphology of neoplastic lesions of skin and adnexae. To describe the spectrum of various neoplastic lesions of skin and adnexae. 7. MATERIALS AND METHODS: 7.1 SOURCE OF DATA: Specimens received from K.R.Hospital, Mysore Medical College and Research Institute, Mysore, over a period of 18 months. Sample size: 60 subjects with neoplastic skin and adnexal lesions. Duration of the study: 18 months (1st December 2012 to 31st May 2014). 7.2 METHODS OF COLLECTION OF DATA Specimens received at pathology department shall be taken up, fixed in 10% formalin and processed. Multiple sections each measuring 4 micron in thickness shall be obtained and stained with haematoxylin and eosin and microscopic features of the lesions shall be studied. Special stains shall be performed wherever necessary and relevant clinical details and laboratory data shall be obtained from subjects records. The final diagnosis in each case will be established by correlative study of clinical and histopathological findings. . 7.3 INCLUSION CRITERIA: Benign and malignant lesions of the skin and adnexae. 7.4 EXCLUSION CRITERIA None . 4 7.5 Does the study require any investigations or interventions to conducted on patients or other humans or animals? If so, please describe briefly Not required be 7.6 Has ethical clearance been obtained from your institution in case of 7.5? Yes (Copy enclosed). 7.7 Duration of study: 18 months (1st December 2012 to 31st May 2014). 8. LIST OF REFERENCES: 1) Waldmann A, Nolte S, Geller AC, et al. Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body Examinations. Arch Dermatol. 2012;148(8):903-910. 2) Adinarayan M, Krishnamurthy SP. Clinicopathological evaluation of nonmelanoma skin Cancer. Indian J Dermatol 2011; 56:670-2 3) Deprez M, Uffer S. Clinicopathological features of eyelid skin tumors. A retrospective study of 5504 cases and review of literature. Am J Dermatopathol.2009 May;31(3):256-62. 4) Nair PS. A clinico-histopathological study of skin appendageal tumors. Indian J Dermatol Venereol Leprol 2008; 74:550. 5) Scrivener Y, Grosshans E, Cribier B.Variation of basal cell carcinoma according to gender, age, location and histopathological subtype. Br J Dermatol.2002 Jul;147(1):41-7 6) Garner A, Koornneef L, Levene A, Collin JR. Malignant melanoma of the eyelid skin: histopathology and behaviour. Br J Ophthalmol. 1985 Mar;69(3):180-6. 7) Wick MR, Goellner JR, Wolfe JT, Su WP. Adnexal carcinomas of the skin. I. Eccrine carcinomas. Cancer.1985 Sep 1;56(5):1147-62. 5 9. Signature of the Candidate : Dr. SHASHIKUMAR. S .D. 10. Remarks of the Guide : 11. Name and Designation of 11.1 Guide : Dr. H. B. SHASHIDHAR. M. D. ASSOCIATE PROFESSOR, DEPARTMENT OF PATHOLOGY, MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE. 11.2 Signature of Guide : 11.3 Head of the Department 11.4 Signature of Head of the Department : Dr. A. L. HEMALATHA. M.D., D.C.P. PROFESSOR AND HEAD, DEPARTMENT OF PATHOLOGY, MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE. : 6 12. Remarks 12.1 Remarks of the Dean and Director : 12.2 Signature of the Dean and Director : 7 ETHICAL COMMITTEE CLEARANCE 1. TITLE OF THE DISSERTATION : “HISTOPATHOLOGICAL STUDY OF NEOPLASTIC LESIONS OF SKIN AND ADNEXAE” 2. NAME OF THE CANDIDATE : Dr.SHASHIKUMAR S.D. 3. SUBJECT : M.D. PATHOLOGY 4. NAME OF THE GUIDE : Dr. H.B SHASHIDHAR., M.D. ASSOCIATE PROFESSOR, DEPARMENT OF PATHOLOGY, MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE. 5. APPROVED/NOT APPROVED (If not approved, suggestion) : APPROVED ` 8 MEDICAL SUPERINTENDENT K.R. Hospital, Mysore. MEDICAL SUPERINTENDENT Cheluvamba Hospital, Mysore. PROFESSOR AND HEAD Department of Medicine, K.R. Hospital, Mysore. PROFESSOR AND HEAD Department of Surgery, K.R. Hospital, Mysore. MEDICAL SUPERINTENDENT PKTB Hospital, Mysore. LAW EXPERT THE DEAN AND DIRECTOR, Mysore Medical College and Research Institute, Mysore 9