DIAGNOSTIC CONCORDANCE IN HYPERPIGMENTED SKIN LESIONS: A CLINICOPATHOLOGICAL PERSPECTIVE

Abstract

Background: Hyperpigmented skin lesions comprise a heterogeneous group of inflammatory, melanocytic, and epidermal disorders with overlapping clinical appearances. Histopathological examination is often required for definitive classification. Objectives: To describe the histopathological spectrum of hyperpigmented sk  in lesions and assess clinicopathological concordance. Materials and Methods: This hospital-based cross-sectional descriptive study was conducted in the Department of Pathology, Saveetha Medical College and Hospital, from January 2023 to January 2024. Fifty clinically diagnosed pigmented skin lesions from patients of all age groups were evaluated. Formalin-fixed, paraffin-embedded sections stained with hematoxylin and eosin were examined, and special stains were used when indicated. Clinical diagnosis, histological type, age, sex, and anatomical location were recorded. Results: The largest proportion of patients belonged to the 21–30-year age group (28%), with a slight female predominance (male:female ratio approximately 1:1.1). Lichen planus, seborrheic keratosis, and psoriasis vulgaris each accounted for 20% of cases. Lichen planus pigmentosus, epidermal nevus, and Becker nevus each constituted 10%, while post-inflammatory dermatosis and intradermal nevus each accounted for 4%; dermatofibroma represented 2%. The most frequent histological findings were elongation of rete ridges and perivascular inflammatory infiltrates. Clinicopathological concordance was observed in 70% of cases. Conclusion: Histopathology provides essential diagnostic clarification in clinically overlapping hyperpigmented lesions. Adequate clinical information combined with systematic microscopic evaluation improves diagnostic concordance.