Oleh:Aries Rahman Hakim, S.Ked082011101017

Pembimbing:dr. Gunawan Hostiadi, Sp.KK

SMF KULIT DAN KELAMIN RSD DR. SOEBANDI JEMBRFAKULTAS KEDOKTERAN UNIVERSITAS JEMBER2012

MELANOMA MALIGNA

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Adalah suatu keganasan yang terjadi pada sel melanosit

dEFINISI

Stratum Korneum

Stratum Lusidum

Stratum Granulosum Stratum Spinosum

Stratum Basale

Melanosit

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• Di Amerika tahun 2008 dilaporkan sebesar 62.480 kasus.• Pada tahun 1930 resiko melanoma maligna 1:11.500,tahun

2000 1:74• Laki-laki : perempuan = 0.97:1

Epidemiologi

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• Nevus• Riwayat Keluarga• Pajanan sinar UV yang berlebihan• Usia• Supresi sistem imun

Faktor Resiko

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• Belum diketahui dengan jelas • Multifaktor • Terjadinya mutasi genetik melalui percepatan

terhadap proliferasi, diferensiasi dan kematianserta pengaruh efek karsinogenik radiasiultraviolet.

Patofisiologi

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Manifestasi klinis

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Stage TNM Classification Histologic/Clinical Features

0 Tis N0 M0 Intraepithelial/in situ melanoma

IA T1a N0 M0 ≤1 mm without ulceration and level II/III

IB T1b N0 M0

T2a N0 M0

≤1 mm with ulceration or level IV/V

1.01-2 mm without ulceration

IIA T2b N0 M0

T3a N0 M0

1.01-2 mm with ulceration

2.01-4 mm without ulceration

IIB T3b N0 M0

T4a N0 M0

2.01-4 mm with ulceration

>4 mm without ulceration

IIC T4b N0 M0 >4 mm with ulceration

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IIIA T1-4a N1a M0

T1-4a N2a M0

Single regional nodal micrometastasis, nonulcerated primary

2-3 microscopic positive regional nodes, nonulcerated primary

IIIB T1-4bN1a M0

T1-4bN2a M0

T1-4a N1b M0

T1-4a N2b M0

T1-4a/b N2c M0

Single regional nodal micrometastasis, ulcerated primary

2-3 microscopic regional nodes, nonulcerated primary

Single regional nodal macrometastasis, nonulcerated primary

2-3 macroscopic regional nodes, no ulceration of primary

In-transit met(s)* and/or satellite lesion(s) without metastatic lymph nodes

IIIC T1-4b N2a M0

T1-4b N2b M0

Any T N3 M0

Single macroscopic regional node, ulcerated primary

2-3 macroscopic metastatic regional nodes, ulcerated primary

4 or more metastatic nodes, matted nodes/gross extracapsular extension, or in-

transit met(s)/satellite lesion(s) and metastatic nodes

IV Any T any N M1a

Any T any N M1b

Any T any N M1c

Distant skin, subcutaneous, or nodal mets with normal LDH levels

Lung mets with normal LDH

All other visceral mets with normal LDH or any distant mets with elevated LDH

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Diagnosis

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Differensial diagnosis

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Penatalaksanaan

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Stage Survival rate selama 5 tahun

Stage I dan II (≤1mm) sebesar 91-95%, (1,01-4mm) sebesar 63-89%, (>4mm) sebesar 67% ulserasi -, dan 45%

ulserasi +.

Stage III Metastase lymphonodi sebesar 13-69%, Pada lesi satelit sebesar 30-50%.

Stage IV Median survival hanya 6-9 bulan dan ketahanan hidup selama 5 tahun sekitar 7-19%

Prognosis

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Laporan Kasus

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Superficial Spreading Melanoma

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TERIMAKASIH