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BACKGROUND Late detection and diagnosis of skin epithelial tumours is primarily related to increased morbidity and mortality. Understanding the risk factors and patterns of malignancy can help early identification and prompt treatment of patients with skin tumours. In the current study, we aimed to study the pattern of skin epithelial lesions in tertiary care centre in central India and study its association with various risk factors. METHODS The skin epithelial lesion biopsies received in the Department of Pathology, GMC, Bhopal for histopathological evaluation during the duration of one and a half years were included in the study. Data was analysed by appropriate statistical tests using SPSS software. RESULTS We found that out of the 64 cases, majority of the patients belonged to the age group of 31-40 and 51-60 years with incidence being quite less among younger age groups with male preponderance. The mean age of presentation of malignant cases was significantly higher (53.2 years) than the age of presentation of benign cases (34 years). The difference was statistically significant (p= 0.003). Majority of the tumours occurred in the head and neck region followed by the lower limbs. The ratio of malignant cases to benign cases was 4.3:1. Among the benign lesions, Naevus and Squamous Papilloma formed bulk of the cases. Squamous Cell Carcinoma (SCC) constituted for 73% of the malignant cases. Basal cell carcinoma and malignant melanoma cases had a lower association with sun exposure as compared to SCC. Most of the cases of SCC occurred at the previous burn site. CONCLUSIONS We found out a wide spectrum of distribution of cases in all age groups with a greater occurrence of lesions in males than females owing to a greater extent of sun exposure in them. The study very well explained the relationship between sun exposure and SCC cases. We studied that many patients developed SCC on a site which had a burn scar. Periodic follow up of burn scar patients and non-healing lesions on head, neck and lower limb area is recommended.

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INTRODUCTION: Renal cell carcinoma (RCC) is the most common malignancy of the kidney. RCC is curative with nephrectomy followed with post-operative surveillance with computed tomography (CT) or magnetic resonance imaging (MRI). RCC recurrence rarely occurs beyond 5 years. We present a 57-year-old woman 8 years post left nephrectomy due to RCC, who presented with an incidental pancreatic head mass on MRI subsequently confirmed as RCC. CASE DESCRIPTION/METHODS: A 57- year old Caucasian woman with a past medical history of recently diagnosed T1a N0M0 colorectal carcinoma (CRC) status post right hemicolectomy and Grade 2 RCC status post left nephrectomy 8 years prior to presentation, underwent post-surgical surveillance for CRC two months post hemicolectomy. She reported no clinical symptoms. Incidental findings on outside hospital MRI of the abdomen and pelvis with contrast demonstrated a 2.5 cm hypodense mass at the pancreatic head (Figure 1). Metastatic work up for CRC including whole body positron emission tomography was negative. She was referred to our institution for endoscopic ultrasonography with find needle aspiration (EUS-FNA) of the pancreatic mass. Blood test showed normal liver function test and CA 19-9. The EUS showed a 2 cm × 2 cm ill-defined hypoechoic and heterogenous in echotexture mass in the head and neck of the pancreas (Figure 2). A 22-gauge needle with a stylet was used to perform FNA. Immunostains showed neoplastic cells positive for PAX-8 and RCC; immunophenotype consistent with clear cell RCC (Figure 3). She underwent successful central pancreatomy with pancreato-gastrostomy without complications. DISCUSSION: This case is extraordinary as RCC recurred after 8 years following nephrectomy as an isolated pancreatic mass following 5-year surveillance without evidence of recurrence. Up to 93% of recurrence occurs within 5 years post nephrectomy and current guidelines recommend RCC surveillance up to 5 years post nephrectomy. EUS-FNA provided a minimally invasive method of accurately diagnosing metastatic RCC and is an excellent tool for evaluating pancreatic lesions. Reporting such a case should raise the awareness among physicians for delayed recurrence of RCC in sites such as the pancreas and further longitudinal studies should be sought to assess the prolonged surveillance strategies to identify such recurrences.