pa the skin.ppt

8/14/2019 PA The skin.ppt

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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; Cylindromas Syringoma Trichoepithelioam


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1. Seborrheic keratoses

Ins: common, benign, pigmented, basalkeratinocytic proliferation, single/multiple

Age:middle/older/adult

Predileksi;trunk Ins: male > female Mac: round, flat, coin plaq mm to cm dark brown,

color tan-black pigmented SK confused

melanoma Mic:the number of epidermal basal cells isgreately; 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

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

ears, hands Mac: flesh colored, dome shaped with central

keratinplug crater, 1cm to sev cm Mic central keratin filled crater surounded with

proliferating epithelial cells Berpotensi menjadi ganas epidermoid

karsinoma


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Dome shaped lesion with central craterfilled with keratin

laki:perempuan=4:1


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4. Appendage tumor

Cylindromas : lesi:nodules on forehead andscalp.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


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Bowens 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 mucosalsurface Pattern growth: multifokal(extended) Nodular (down ward) Mic: like normal basal layer of the

epidermis(palisading) basal cell proliferating


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Disorder of pigmentation

Lentigo dont involve proliferation ofmelanocyt 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

melanocytic hyperpigmented basal celllayer in the epidewrmis


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Pigmented naevus

Mac: congg/acquired 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 abnormalgrowth (atypia)

This type is precursor of malignantmelanoma.


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Malignant melanoma

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

darkly pigmented (tanning fad?) Predisp: sunlightpre 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=levation

Jenis: superficial spreading melanoma;nodular melanoma; acral lentigomelanoma


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Clark levellary dermis I: intraepidermal II: in the papil 100% III: papilary-reticularis 88% IV: reticularis 66% V: subcutaneus fat 15%

pa the skin.ppt

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