Retrospective analysis of skin appendage tumor cases

Introduction and Aim: Skin tumors are the most commonly observed tumors worldwide. Skin appendage tumors (SAT) are neoplasms that differentiate in various directions and have histological features resembling skin appendages. Most of them are benign, but occasionally, malignant skin appendage tumors can also be observed. Skin tumors have various causes such as genetic, chemical, hormonal, nutritional, viral, and environmental factors. Many skin appendage tumors can be seen in all age groups, and although some have extracutaneous counterparts, most are specific to the skin. The aim of this study was to examine the epidemiological characteristics of patients with skin appendage tumors treated in our clinic, to evaluate the patients in terms of gender and age, to evaluate the tumors in terms of size, location and histological type, to evaluate the surgical techniques used in the treatment of patients and to evaluate the patients with malignant skin appendage tumor in terms of reexcision, recurrence, sentinel lymph node biopsy, lymph node dissection, mortality status and duration of mortality. Materials and Methods: The study was performed retrospectively on 219 cases (benign: 159, malignant: 60) with benign and malignant skin appendage tumors treated in the Plastic Reconstructive and Aesthetic Surgery Clinic of Manisa Celal Bayar University Medical Faculty Hospital between May 2010 and May 2022. The study was created by using the data in the archive files of the patients hospitalized in the Plastic Reconstructive and Aesthetic Surgery Clinic of Manisa Celal Bayar University Faculty of Medicine Hospital. Results: In our study benign skin appendage tumors were observed in 159 (72,6%) of 219 cases, while malignant skin appendage tumors were observed in 60 (27,4%) cases. In our study 62 (39%) of the patients with benign skin attachment tumours were consisted of female and 97 (61%) were consisted of male, while 34 (56,7%) of the patients with malignant skin attachment tumours were consisted of female and 26 (43.3%) were consisted of male. Studies in the literature have shown that benign skin appendage tumors are more common than malignant skin appendage tumors (18,85,86). It was observed that the average age of cases with benign skin appendage tumors in our study was 45,37±22.68 years (min-max: 1-93) and the average age of cases with malignant skin appendage tumors was 72,51±14.13 years (min-max: 24-96). It was observed that the difference in average ages between the groups was statistically significant (p<0.05). It was observed that the average age of male cases (46,07±23,21 years) in benign skin appendage tumors was higher than that of female cases (44,94±22,01 years). It was observed that the average age of female cases (75,53±12,4 years) in malignant skin appendage tumors was higher than that of male cases (68,54±15,42 years). Evaluating the frequency of occurrence of skin appendage tumors in our cases, it was founded that 40 (25,2%) of benign cases had sebaceous nevus and 29 (18,2%) had pilomatrixoma, while 17 (28,3%) of malignant cases had porocarcinoma and 12 (20%) had sebaceous carcinoma. In benign skin appendage tumors it was observed that the most common types in female cases were pilomatrixoma (15 cases, 9,43%) and hydradenoma (13 cases, 8,18%), while in male cases sebaceous nevus (30 cases, 18,87%) and pilomatrixoma (14 cases, 8,81%) were the most common types. In malignant skin appendage tumors it was observed that the most common types in female cases were porocarcinoma (10 cases, 16,67%), sebaceous carcinoma (8 cases, 13,33%) and proliferating trichilemmal tumor (8 cases, 13,33%), while in male cases porocarcinoma (7 cases, 11,67%) and trichilemmal carcinoma (7 cases, 11,67%) were the most common types. In our study it was observed that 22 (16,4%) of benign skin appendage tumors were located in the scalp and 17 (12,7%) of them were in the malar region, 10 (16,67%) of malignant skin appendage tumors were located in the eyelid and 9 (15%) of them were in the malar region. In studies conducted in the literature, it was observed that skin appendage tumors were most common in the head and neck region (87,92,93). It was founded that the average size of benign lesions in our study was 1,47±1,41 cm, while the average size of malignant lesions was 3,13±2,58 cm. In benign lesions, it was observed that the average size of fibrofolliculoma type (10 cm) and keratinous cyst (trichilemmal type) (2,83±2,82 cm) were higher than other types and the differences in lesion sizes by lesion type were statistically significant (p<0.05). In malignant lesions, it was observed that the average size of proliferating trichilemmal tumor type (4,65±3.15 cm) and trichoblastic carcinoma type (4,50±3,57 cm) were higher than other types and the differences in lesion sizes by lesion type were statistically significant (p<0.05). It was observed that the mean size of the lesions (1,47±1,51 cm) in female cases with benign skin appendage tumor was higher than in males (1,45±1,34 cm). It was observed that the mean size of the lesions (3,24±2,69 cm) in female cases with malignant skin appendage tumor was higher than in males (3,07±2,55 cm). In our study graft application was performed in 15 (9,43%) cases with benign skin appendage tumor and primary repair was performed in 114 (90,57%) cases. Flap application was performed in 19 (33,93%) cases with malignant skin appendage tumor, graft application was performed in 22 (39,29%) cases and primary repair was performed in 15 (26,79%) cases. In benign cases primary repair was performed most common in patients with sebaceous nevus (36 patients, 22.64%) and pilomatrixoma (29 patients, 18.24%), while repair with grafting was performed most common in patients with sebaceous nevus (4 patients, 2.52%) and hydradenoma (4 patients, 2.52%). In malignant cases repair with grafting was most common performed in patients with porocarcinoma (7 patients, 12.5%) and proliferating trichilemmal tumour (6 patients, 10.71%), while repair with flap was most common performed in patients with sebaceous carcinoma (5 patients, 8.93%) and trichoblastic carcinoma (5 patients, 8.93%). Reexcision was performed in 9 (15%) of the malignant patients and recurrence developed in 8 (13,33%). Sentinel lymph node biopsy was performed in 7 (11,66%) of the malignant patients and the result was positive in one patient with a diagnosis of trichoblastic carcinoma. Lymph node dissection was performed in 5 (8,33%) of the malignant patients and the result was positive in one patient with a diagnosis of porocarcinoma. There are two (3,33%) patients who received radiotherapy in the malignant group and there was no patient who received chemotherapy. Systemic metastasis was found in one (1,66%) case. Mortality developed in 26 (43.33%) of the cases diagnosed with malignant skin appendage tumor. The cases with the highest mortality were those with porocarcinoma (13 cases, 21,67%) and trichoblastic carcinoma (7 cases, 11,67%). It was observed that the average age of cases with mortality (75,65±15,88 years, min:24 max:96) was higher than that of cases who survived (70,09±12,34 years, min:33 max:90). It was observed that the average lesion size of cases with mortality (3,27±2,77 cm, min:0.5 max:10) was higher than that of cases who survived (2,99±2,533 cm, min:0.3 max:12).It was fonded that when variables affecting the development of mortality were examined in cases, age, lesion type, and lesion size were found to be effective factors, while gender did not affect the development of mortality. Conclusion: In our study it was observed that most of the skin appendage tumors were benign. It was observed that benign lesions were more common in male patients and malignant lesions were higher in female patients. Malignant lesions were observed in elderly patients, while benign lesions were observed in younger patients. It was observed in cases with benign lesions the most common localizations were the scalp and malar region and in cases with malignant lesions the most common localizations were the eyelid and malar region. It was observed that sebaceous nevus and pilomatrixoma types were most common in cases with benign lesions and porocarcinoma and sebaceous carcinoma types were most common in cases with malignant lesions. Primary repair was most common performed in the treatment of benign lesions, while repair with grafting was most common performed in the treatment of malignant lesions. Malignant skin appendage tumors are tumors that can be aggressive, can metastasize distantly with nodal involvement and can progress with mortality. It is important to follow up the patients at regular intervals in terms of early diagnosis and prevention of recurrence in skin appendage tumors. People should be informed about skin cancer symptoms and sun protection methods. Keywords: skin appendage tumor, benign tumor, malignant tumor