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TUMOR KULITTUMOR KULIT
Dr. M. SYAFEI HAMZAH, SpKKDr. M. SYAFEI HAMZAH, SpKK
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Klasifikasi • Berdasarkan : - Pertumbuhan Jinak & Ganas - Asal tumor
Pertumbuhan• 1. Tumor Jinak• 2. Pre-kanker• 3. Tumor Ganas
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Berdasarkan asalnya :
• 1. Tumor asal epidermis• 2. Tumor asal sel melanocyte • 3. Tumor asal mesodermal • 4. Vascular tumors• 5. Tumor mesodermal lain • 6. Lymphoreticular tumors• 7. Tumor yang metastase ke kulit
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Bagaimana mendiagnose tumor kulit ?
• 1. Riwayat Penyakit• 2. Pemeriksaan fisik• 3. Pemeriksaan Laboratorium. • 4. Patologi anatomi
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Riwayat Tumor
• Kapan ?• Dimana ?• Perdarahan ? / Nyeri ? /
Pembengkan?• Riwayat keluarga ?• Apakah pernah operasi sebelum ?• RIwayat kesehatan ?• Pengobatan ?
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Pemeriksan fisik
• Pemeriksaan Umum :
• Pemeriksaan Kulit / Tumor :
• “ A - B - C - D - E “•(esp. Melanoma maligna)
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“A-B-C-D-E “ tumor
• A : Asymetri
• B : Border
• C : Color
• D : Diameter
• E : Enlargement
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Pemeriksaan Patologi anatomi
• Biopsi :
• Methode : eksisi
punch biopsy
fine needle biopsy
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TUMOR JINAK
• 1. Keratosis seboroik
• 2. Nevus pigmentosus
• 3. Siringoma
• 4. Trikoepitelioma
• 5. Xanthelesma
• 6. Dermatofibroma
• 7. Keloid
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Tumor Prakanker
• 1. Keratosis aktinik
• 2. Penyakit Bowen
• 3. Leukoplakia
• 4. Fibroepitelioma
• 5. Giant condiloma
• 6.Liken sklerosus
• 7. Xeroderma pigmentosum
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TUMOR GANAS
• 1. BASALIOMA
• 2. SKUAMUS SEL KARSINOMA
• 3. MELANOMA MALIGNA
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1. Basalioma
• = tumor ganas kulit yang berasal dari sel epidermal pluripotensial atau dari epidermis/adneksanya
• Sinonim : - Basal cell carcinoma - Basal cell epithelioma - Ulcus roden / Rodent ulcer
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EPIDEMIOLOGI :
• US : 146 per 100.000• Australia : 726 per 100.000
• Pada dekade terakhir terlihat peningkatan yang signifikan insiden Basalioma di Eropa dan Amerika
• Indonesia : ?
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Faktor Predisposisi
• Faktor Lingkungan• Faktor genetik
• Umur : diatas 40 years• Sex : laki-laki > wanita• Ras : jarang pada orang kulit
hitam
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Faktor lingkungan • Radiasi• Bahan kimia : arsen• Pekerjaan -> sinar matahari• Trauma, ulkus sikatriks
Faktor genetik• Xeroderma pigmentosum• Nevoid basal cell carcinoma
syndrome• Albinism
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Gejala klinik
• Distribusi : “sun-exposed area”
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Gejala Klinik (2)
• Tumor bersifat invasif• Jarang mempunyai anak sebar• Dapat merusak jaringan sekitarnya• Cendrung residif
• Warna : Pink atau merah Coklat sampai hitam • Palpasi : Keras , firm bisa ada kista • Bentuk : bulat, oval, bag tengah ada cekungan (umbilicated)
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Variants
• Noduloulcerative type• Sclerosing type (“morphea-like”
type)• Superficial (multicentric) type• Pigmented type
• -William A. Caro• - Thomas B. Fitzpatrick
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Patologi anatomi
• Lokasi : Epidermis & dermis
• Process : Proliferating atypical basal cells (large, oval, deep-blue staining on H&E, but with a little anaplasia and infrequent mitoses) with variable amounts of stroma.
• Thomas B. Fitzpatrick
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Pengobatan :
• Bedah Skalpel Listrik beku • Radiotherapi• Topikal : 5 fluoro uracyl -> 4- 6 mg
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2. Karsinoma sel skuamosa
• = proliferasi yang ganas dari sel keratinosit epidermis
• Sinonim : - Epitelioma sel skuamosa - Karsinoma sel prickle - Karsinoma epidermoid - Pavement epithelioma - Karsinoma Bowen
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Epidemiologi (1)
• Insiden : AS : 7 -12 per 100.000 kulit putih
1 per 100.000 kulit
hitam • Umur : 40 - 50 years
• Sex : laki-laki > wanita
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Etiologi :
• - Sinar matahari• - Ras/herediter • - Faktor genetik• - Arsen inorganik• - Radiasi• - Faktor Hidrokarbon • - Sikatriks, keloid, ulkus kronik
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DISTRIBUSI
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Histopatologi
• 1. Bentuk Intradermal keratosis solaris, kornu kutanea, keratosis arsenikal, penyakit
bowen 2. Bentuk Invasif Dapat terjadi dari : - Bentuk intradermal - bentuk pra kanker - de novo (kulit normal)
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Gejala Klinis
• Nodus yang keras dg batas tidak tegas• Permukaan licin -> verukosa/papiloma• Dijumpai skuamasi• Kmd menjadi keras, membesar ke samping
dan jar. lebih dalam • Invasi ke jar. lunak, otot, serta tulang• Ulserasi : mulai dari tengah, diikuti pbtk
krusta dg pinggir yg keras & mdh berdarah
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Pengobatan• Dapat bermetastase jauh• ~ Basalioma• Utk kasus yg undifferentiated type -
> tindakan lebih agresif (bedah/radiasi)
• Tergantung : - diagnosis dini - cara pengobatan - kerjasama antara os dan dokter
Prognosis
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Epidemiologi :• USA : 1960 : 1 in 600• 1992 : 1 in 105• 2000 : 1 in 75• Insiden pada wanita ~ pria• Umur : 30 -60 tahun
3. Melanoma maligna
• Melanoma disebabkan oleh transformasi keganasan dari sel melanocyt
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Etiologi :
• Yang pasti belum diketahui.• Faktor yang penting : # faktor keganasan # iritasi yg berulang pd tahi lalat # faktor herediter
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Gejala Klinis
• Bentuk dini sulit dibedakan dengan tumor lainnya
• MM fatal jika telah metastase jauh
• Lokasi : ektremitas bawah >>
badan, kepala,leher dan
ektremitas atas
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Bentuk Melanoma Maligna
• 1. Bentuk Superfisial
• 2. Bentuk nodular
• 3. Lentigo Maligna
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1. Bentuk Superfisial
• Yg paling sering ditemukan
• Bercak uk bbrp mm – cm
• Warna : waxy, kehitaman, kecoklatan,
putih, biru.
• tak teratur, batas tegas dg sedikit penonjolan di permukaan kulit.
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2. Bentuk Nodular
• Kasus : 32 %
• Nodus , warna biru kehitaman
batas tegas,
• Bentuk variasi :
- di epidermal -> permukaan licin
- yg menonjol btk tidak teratur
- bentuk eksofilik disertai ulserasi
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3. Lentigo maligna melanoma
(LMM)• Merupakan 14 % kasus
• Sering pada orang tua
• Bentuk plakat, batas tegas
warna coklat kehitaman, tidak homogen
bentuk tak teratur, pd bag tertentu dpt tumbuh nodus yg bbatas tegas.
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Pengobatan
• Bedah
• Sistemik / kemoterapi : - DTIC (Dimethil Triazon Imidazole Carboxamide)
- Me-CCNU (Methyl Nitro Sourea)
- Kombinasi
• Ajuvan : imunoterapi + BCG
kombinasi BCG + dekarbazin