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Dermal patologicdr. Muhartono, M.kes, Sp.PA

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Benign epithelial tumors

1.Seborrheic keratoses2.Fibroepithelial tumor (skin tag

acrochordon, soft fibroma, fibroma molle)

3.Keratoacanthoma4.Appendage tumor

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1. Seborrheic keratoses

• Ins: common, benign, pigmented, basal keratinocytic proliferation, single/multiple

• Age:middle/older/adult• Predileksi;trunk• Ins: male > female• Mac: round, flat, coin plaq—mm to cm dark

brown, colortan-black pigmented SK confused melanoma

• Mic:the number of epidermal basal cells is greately; acantotic; pseudohorny cysts

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2. Fibroepithelial tumor

• Ins: most common of thew cutaneus tumor• Age:midle/older• Predileksi: neck, trunk, face, Intertrigo areas• Mac:soft flesh color, small stalk• Mic: fibrovascular cores covered by

squamous epithel• Biologically : associated: DM, intestinal

polyposis• pregnancy

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3. Keratoacanthoma keratin horn atau cutaneus horn

• Age: >50y of age caucasians• Predilecti: sun exposed skin cheeks

nose, ears, hands• Mac: flesh colored, dome shaped with

central keratinplugcrater, 1cm to sev cm• Mic: central keratin filled crater surounded

with proliferating epithelial cells• Berpotensi menjadi ganasepidermoid

karsinoma

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• Dome shaped lesion with central crater filled with keratin

• laki:perempuan=4:1

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4. Appendage tumor

• Cylindromas: lesi:nodules on forehead and scalp.appear early in life

• Mic:appocrine differentiation• Syringoma: lesion of eccrine differentiation• Lesi occur as multiple on the lower eye lids• Trichoepithelioam: hair follikel

differentiation• Lesi occur on the face,scalp,neck and

upper trunk

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Premalignant epidermal tumor

Actinic keratosis (solar keratosis)• prior developt malignancy!epidermis• Ac keratosis progresive dysplasia sun exposure• Keratin , • other causes: radiation, hydrocarbon,

arsens15• Mutasi p53

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Actinic keratosis

• Mac: diameter lesi <1cm• Red, brownskin color,efl: papule/plaq—prod

keratin(keratin horn)• Mic: epidermis (lowermost layer)atypic cells• Basal layer evidence of dyskeratosis with pink

or red cytoplasma• Basal membrane intake• Dermis: thickened, bluegray,

elasticfiberselastosis (abn fiber synt, sun damage fibroblast)

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Bowen’s disease

• Indolent, scaly, erytematous plaques

• Carcinoma insitu

• Mic: atypical changes

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Malignant tumor

1. Squamous cell carcinoma • Most common type• Sun exposed sites, older people• Male. female• Predisposisi fact: sun light, chronic

ulcers, old burns scar, industrial carcinogens (tars & oils), arsen, radiation

• Mucosa (oral cav); tobacco

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1. Squamous cell carcinoma…

• Mac: well demarcated, red scalling plaqs, or nodular, hyperkeratotic ulceration

• Mucosal leukoplakia• Mic: epidermal atypia,• Well diufferentiated (with prominent

keratinisasition ) to highly anaplastic with necrosis and abortive keratinisation

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2. Basal cell carcinoma

• Common, slow growing, very rare metastase• Chronic sun exposure lightly pigmented

people• Age: middle >40y• Predileksi; face,head not occur in mucosal

surface• Pattern growth: multifoka l(extended)• Nodular (down ward)• Mic: like normal basal layer of the

epidermis(palisading)—basal cell proliferating

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Disorder of pigmentation

• Lentigo don’t involve proliferation of melanocyt cel

• Ins: all ages (also infancy & childhood)

• All sex• No racial predilection• Cause; unknown• Mac: can involve skin &mucosa

membrane

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Lentigo

• Mac: 5-10 mm,oval,brown macules• Mic : hyperplasia

melanocytichyperpigmented basal cell layer in the epidermis

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Pigmented naevus

• congenital/acquired• Mac: 1cm, uniform pigmented• Papules & well defined, rounded borders• Dark brown• Mic: • junctional naevus:naevus cell along the

dermoepidermal junction• Intradermal naevus• Compound naevus: when the melanocyt

nest within both dermis & junctional

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Dysplastic naevus

• Have characteristic features• Mic : compound naevus with

architecture and cytologic evidence of abnormal growth (atypia)

• This type is precursor of malignant melanoma.

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Malignant melanoma

• Common (relative)deadly• Sun light important role; hereditery?• Lightly pigmented individuhigher risk, than

darkly pigmented (tanning fad?)• Predisp: sunlight

pre existing naevus: eg dysplastic naevus

• Mic: melanoma cells (individual) (>naevus cell)

• Large nuclei, irregular chromatin, prominent nuclear

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• Pemeriksaan klinis A=asimetri; B=border; C=color; D=diameter; E=elevation

• Jenis: superficial spreading melanoma; nodular melanoma; acral lentigo melanoma

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• Clark levellary dermis– I: intraepidermal– II: in the papil100%– III: papilary-reticularis88%– IV: reticularis66%– V: subcutaneus fat15%