LESI GANAS KULIT

FAKULTAS KEDOKTERANUNIVERSITAS METHODIST INDONESIA

MELANOMA RADIAL GROWTH PHASE MELANOMA

(SUPERFISIAL SPREADING) the very beginning of malignant melanoma.

VERTICAL GROWTH PHASE MELANOMA

RADIAL GROWTH PHASE MELANOMA (SUPERFISIAL SPREADING)

PATHOGENESIS

Arise from neoplastic transformation of normally epidermis melanocytes proliferation superficial spreading invasive metast to lymphatic/hematogen

CLINICAL FEATURE

Change in a mole developed Itching Increase size Lesion darkening

MACROSCOPICALLY Early melanoma radial growth phase Slightly elevated & palpable border Variably colored some parts unusually

black / dark brown Lighter brown shade mingled with pink &

light blue tints Entire lesion purely dark brown occasionaly

MICROSCOPICALLY Large epitheloid melanocytes dispersed in

nests / as individual cells entire thickness of epidermis

Brisk lymphocytis response May be only in epidermis (in situ) Focal extension papillary dermis is rule Grow in all directions Dermal mitoses (-)

VERTICAL GROWTH PHASE MELANOMA

1-2 years of radial growth character of growth change focally

Focal mitotic activity (+) Grow as spheroidal nodules Expand rapidly in surrounding papillary

dermis Net direction growth perpendicular

CHARACTERISTIC VERTICAL GROWTH PHASE

Cells differ in appearance little / no pigment ; radial : melanotic

Cellular aggregate characteristic vertical Larger cluster cells extend into lower half

reticular dermis Host cellular immune response (-)

TYPES :

1. Metastatic Melanoma

2. Nodular Melanoma

- Rarest form

- Radial growth phase (-)

- Malignant character expressed in initial

lesion

3. Lentigo Malignant Melanoma

- Usually in fair, elderly & whites

= Hutchinson’s freckle

4. Acral Lentiginous Melanoma

- Most common form dark-skinned

- Limited to palm, sole & subungual region

PROGNOSIS

1. Type of melanoma Lentigo better

2. Depth of invasion Breslow’s thickness

3. Level of invasion Clark

4. Number of inflammatory cells

5. Clinical Stage

6. Sex : female better

7. Regression (+) poorer prognosis

Lentigo maligna melanoma

Lentigo maligna

Lentigo maligna melanoma

Superficial spreading melanoma

Superficial spreading melanoma

Superficial spreading melanoma

Acral lentigo melanoma

Acral lentigo melanoma

Acral lentigo melanoma

Acral lentigo melanoma

Nodular melanoma

Nodular melanoma

Nodular melanoma

SKIN CARCINOMA

1. BASAL CELL CARCINOMA

2. SQUAMOUS CELL CARCINOMA

BASAL CELL CARCINOMA

Most common pale skin Locally aggressive Rare metastases

PATHOGENESIS Develop on sun damaged skin fair skin &

freckles Fingers & dorsum of hand Derived from pluripoten cells of basal layer Differentiated along skin appendage lines

CLINICAL FEATURE Pearly papule prototypic lesion Rodent ulcer small crater in center of pearl Superficial BCC scaly, red, sharply

demarcated plaque Morphea-like BCC ill defined, pale, firm, scar-

like tumor Pigmented BCC grossly resembles malignant

melanoma

PATHOLOGY Multiple nests of deeply basophilic epithelial cells

attached to epidermis protude into papillary dermis

Central part compose of closely packed keratinocytes

Nuclei deeply basophilic surround by small rim cytoplasm

Periphery nests composed of an organized layer of polarized, columnar keratinocytes

SQUAMOUS CELL CARCINOMA

Cancer of epidermis whose cells resemble differentiated keratinocytes

Incidence : second only to BCC Caused by UV, radiation, chemical

carcinogens, HPV Often originates in actinic keratoses

PATHOGENESIS

Related to UV light Chronic scarring process > metastase

than solar-related SCC

CLINICAL FEATURE

Arise on hand, face, lip / ear Small lesion, scaly / ulcerated

PATHOLOGY Composed of tumor cells mimic

epidermal stratum spinosum extend into subjacent dermis

Variably thickened & parakeratotic Atypia basal keratinocyte (+)

Squamous cell carcinoma in situ, medium power. The normal maturation pattern of keratinocytic apithelium is disturbed, imparting a “windblown” look to the neoplastic epithelium. There is a parakeratotic scale

Squamous cell carcinoma in situ, high power. The lesional cells exhibit nuclear attributes of malignancy-enlargement, hyperchromatism, pleomorphism, and dyskeratosis