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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%