From clinic to microscope: A study of clinicopathological concordance in 5000 skin biopsies from a tertiary care center

INTRODUCTION: Skin, hair, and nail diseases can greatly impact psychosocial well-being, making an accurate diagnosis essential. Skin biopsies are a key diagnostic tool in dermatology, aiding in identifying and distinguishing various skin conditions. This study was done to determine the spectrum of diseases requiring skin biopsy and the level of clinicopathological concordance. MATERIALS AND METHODS: We retrospectively reviewed 5000 skin biopsy records at a tertiary care center over 2 years. Data included demographics, biopsy sites, lesion morphology, clinical indications, and histopathological diagnoses. The Chi-square test assessed the concordance between clinical and histopathological findings ( P < 0.05). RESULTS: Of 5000 biopsies, 56.2% were from males, with peak incidence in the 35-40 age group. The most biopsied sites were the lower limb (22%), with plaques being the most common lesion morphology (37.9%). Papulosquamous disorders (24.7%) were the leading indication, particularly Lichenoid dermatitis (9.6%), followed by cutaneous infections (14.7%), mainly mycobacterial (9.2%). Lichen planus (6.2%) and psoriasis (4.5%) were the most frequent histopathological diagnoses. Overall, clinicopathological concordance was 86%, with 50.6% full and 35.4% partial concordance. Variability in concordance rates was seen across disease categories. CONCLUSION: Skin biopsy plays a vital role in diagnosing dermatological conditions, with an 86% concordance rate. Variability across conditions highlights the importance of clinicopathological correlation and careful clinical evaluation.